Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study

Abstract

BACKGROUND: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The treatment for these fractures depends upon age, type of injury and whether the physics is closed or not.
 AIM: Comparison between radial head excision versus radial head replacement based on mayo elbow scoring in comminuted radial head fractures.
 MATERIAL AND METHODS: We did a prospective comparative study comprising 32 patients between age 22-60 years with Mason type II/III radial head fractures at Sir J.J Group of Hospitals, Mumbai. The patients were randomised using the admission day of the week placing 17 patients in the arthroplasty group and 15 patients in the excision group. The patients were followed up for 18-24 months (average 20 months) postoperatively. Results were analysed by the Mayo’s elbow performance score at 6 months and 18 months and were statistically evaluated by unpaired t-test.
 RESULTS: At 6 months, radial head arthroplasty gave excellent results in 2 patients, good in 5 patients and fair in 8 patients. In excision, there were 5 patients with excellent results at 6 months, 7 with good results and 2 with fair results. At 18 months, of the 17 patients who had undergone head arthroplasty, 2 had excellent results, and the same number had poor results. 7 (46.7%) of the 15 cases who had undergone radial head excision had excellent results. Good results were obtained in 7 cases of each. There was 6 cases (35.3%) of radial head arthroplasty which fell into the fair group. As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 68.82 and 18.66 respectively & for excision, it was 85.66 and 10.66. At 18 months follow up, it was 75 and 14.89 for arthroplasty & 90.66 and 7.98 for excision. The difference between the results was statistically significant (p < 0.01).
 CONCLUSION: Our study shows that long and short-term results of radial head excision are better as compared to arthroplasty in comminuted radial head fractures based on mayo elbow scoring, particularly for dominant upper limbs.

Elbow arthroplasty research methods, outcome domains, and instruments used in clinical outcome studies

“…There were 23 administrative database studies, 21 of which were conducted in the USA, and eight national registry studies from Australia, Denmark (two studies), Norway, Finland, Sweden, and New Zealand. There were six prospective RCTs, [25][26][27][28][29][30] one retrospective review of patients from a previous RCT, 31 and three RCT protocols. [32][33][34] The authors of two RCTs compared total elbow arthroplasty with osteosynthesis of distal humeral fractures, one reporting results at two years and one retrospective review of the same cohort at a mean follow-up of 12.5 years.…”

“…29 Three studies compared the outcome of radial head arthroplasty with osteosynthesis for an acute radial head fracture, and one compared radial head arthroplasty to excision of the radial head. 25,27,28,30 Two protocols compared total elbow arthroplasty with distal humeral hemiarthroplasty for distal humeral fracture, and one protocol compared distal humeral hemiarthroplasty with osteosynthesis. [32][33][34] None of the RCTs compared elbow arthroplasty with non-operative management.…”

“…Only one RCT had a stated source of funding which was from a commercial source. 26 In five RCTs, it was stated that there was no funding or conflict of interest for the trial, 25,28,29,31,33 and this was not reported in four studies. 27,30,32,34 The median sample size by study design is shown in Table III.…”

A Comparative Study Showing Elbow Kinematics in Radial Head Replacement Versus Radial Head Excision Versus Radial Head Fixation

“…For fixation ideally the fracture should have 3 or fewer fragments and these fragments must be large enough to accept a screw for fixation and should have minimal metaphysial bone loss, thus making fixation a difficult entity. Fixation leads to complications like osteonecrosis, nonunion, or displaced fragments [9].…”

Functional outcomes evaluation after radial head arthoplasty in DR. Syaiful Anwar General Hospital: Case series

“…The most common etiology of radial head fractures is direct trauma. Static loading traversing the elbow was transmitted through the radio-capitellar articulation, bearing 60% of the elbow force [ 6 ].…”