Mid-term outcomes of surgical management of complex, isolated radial head fractures: a multicentre collaboration

Gokaraju, Kishan; Dömös, Peter; Aweid, Osama; Fisher, Rachael; White, Andrew A.; Rensburg, Lee Van; Kang, Sertaz-Niel

doi:10.1007/s00590-020-02709-z

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…Indeed, this hybrid approach availably decrease the risks of failure in xation and provide a good clinical result. Arthritis [6] Grade 1 [5] Grade Elbow Self-Assessment [15] Very good [1] Good [5] Satisfied [5] Sufficient…”

Section: Discussionmentioning

confidence: 99%

“…At present, there is considerable con icting evidence in the literature regarding the treatment of comminuted and displaced fractures of the radial head [2,3,6,19]. Although RHR as early treatment has been reported with satisfactory to poor outcomes, the radiocapitellar contact is seriously damaged, leading to the instability of valgus or posterolateral rotation, decreased strength, and degenerative changes in elbow and wrist [20].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, it has been well recognized that the radial head is an important stabilizer of the forearm and elbow [4]. The emergence of speci c radial head implants and innovative techniques have made ORIF preferable to preserve the integrity of the fractured radial head [5][6].…”

Section: Introductionmentioning

confidence: 99%

“…speci c radial head implants and innovative techniques have made ORIF preferable to preserve the integrity of the fractured radial head [5][6].…”

mentioning

confidence: 99%

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A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

Gao

Dai²,

Yin³

et al. 2021

Preprint

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Background: Management of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, the present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. A hybrid technique combining with intramedullary pining was performed in our study to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. Methods: The clinical, functional and radiographic outcomes of the groups were compared during follow-up. The radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion (ROM) in the elbow, Visual Analog Scale (VAS) score, Elbow Self-Assessment score (ESAS), Mayo Elbow Performance score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.Results: Fifteen patients with unstable fractures were participated with an average follow-up of (37.2±5.8) months for the experimental group and (33.2±7.1) months for the control group, respectively. The ROM of the elbow and functional outcomes in the experimental group, including MEPS and DASH, were significantly superior to the control group. However, no significant difference was observed in the mean VAS score between two groups. In the last follow-up, two patients with post-traumatic arthritis rated as grades 1 and two with heterotopic ossifications were observed in the experimental group. In the control group, degenerative changes were observed in four cases (grade 1 in three cases and grade 2 in one case) and heterotopic ossifications rated as grade I were found in two patients. Conclusion: Collectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique. Trial registration: This study was retrospectively registered

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…speci c radial head implants and innovative techniques have made ORIF preferable to preserve the integrity of the fractured radial head [5][6].…”

mentioning

confidence: 99%

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A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

Gao

Dai²,

Yin³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…At present, there is considerable con icting evidence in the literature regarding the treatment of comminuted and displaced fractures of the radial head [2,3,6,19]. RAS as early treatment has been rarely indicated since the radiocapitellar contact is seriously damaged, leading to the instability of valgus or posterolateral rotation, decreased strength, and degenerative changes in the elbow and wrist [20].…”

Section: Discussionmentioning

confidence: 99%

A Hybrid Technique Combining Intramedullary Pinning With Extramedullary Plate Fixation in Unstable and Comminuted Radial Head Fractures Following on-Table Reconstruction

Gao

Li²,

Sui

et al. 2020

Preprint

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BackgroundManagement of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, since only a few previous studies have investigated small amounts of patients with conflicting complication rates, the treatment effects of on-table technique may be discrepant in different cases and its reliability needs to be evaluated cautiously in the practical surgical process. The present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. Subsequently, a hybrid technique combining with intramedullary pining was performed to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. MethodsFive patients with unstable comminuted radial head fractures (Mason type-III) were selected from January 2012 to May 2018 in this study. All patients were treated with open reduction and internal fixation using extramedullary plate and intramedullary pinning. During follow-up, the radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion in the elbow, Visual Analog Scale score, Elbow Self-Assessment score, Mayo Elbow Performance score, and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score.ResultsAfter a mean follow-up of 44 months (range, 36 to 48), the average range of motion in elbow flexion-extension was 125° with supination of 84°and pronation of 74°. Based on the Elbow Self-Assessment score, there was one very good, two good, one satisfied, and one sufficient, respectively. The mean Visual Analog Scale score for pain was 1 (range, 0 to 3) and the mean Mayo Elbow Performance score was 83 (range, 70 to 95). The DASH score revealed good to excellent results with a mean score of 10 (range, 2.3 to 27). Two patients had mild signs of posttraumatic arthritis, and heterotopic ossifications rating as grade I were observed in three patients. However, none of them was affected in daily life. ConclusionCollectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

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Controversies in the Management of Radial Head Fractures in Adults

Ruiz-Pérez¹,

Gómez-Cardero²,

Rodríguez-Merchán³

2022

Controversies in Orthopedic Surgery of the Upper Limb

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Mid-term outcomes of surgical management of complex, isolated radial head fractures: a multicentre collaboration

Cited by 8 publications

References 24 publications

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

A Hybrid Technique Combining Intramedullary Pinning With Extramedullary Plate Fixation in Unstable and Comminuted Radial Head Fractures Following on-Table Reconstruction

Controversies in the Management of Radial Head Fractures in Adults

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