Preserving the radial head in comminuted Mason type III fractures without fixation to the radial shaft: a mid-term clinical and radiographic follow-up study

Gregori, Markus; Zott, Stephanie; Hajdu, Stefan; Braunsteiner, Tomas

doi:10.1016/j.jse.2019.07.036

Cited by 9 publications

(5 citation statements)

References 55 publications

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“…Interestingly, Gregori et al recently reported a technique that the radial head was placed in its anatomic position after in vitro reconstruction, and no plate was used for fixation with the radial shaft. Compared with the traditional anatomic plate internal fixation, Mayo’s elbow function score was higher, although 70% of the cases developed nonunion [ 7 ]. For Mason III fractures with radial neck, whether the use of pre-curved metacarpal plate for sole reconstruction of radial head was reliable deserves further elucidation.…”

Section: Discussionmentioning

confidence: 99%

“…And the plate is hard to be placed at the ideal position (i.e. the “safe zone” of the radial head) [ 6 ], which results in a high incidence of hardware failure and a decreased range of motion [ 7 ]. Headless compression cannulated screws have shown advantages in the fixation of simple intra-articular fracture fragment, but we found that it is challenging to fix comminuted or thin fracture fragment with screws, in which the screws are hard to maintain the mini-fragment stability or increase the incidence of iatrogenic fracture.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of radial head fractures treated with pre-curved metacarpal plate

Yang,

Zhuang,

Xiaosong

et al. 2023

BMC Musculoskelet Disord

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Objective To explore the clinical outcomes of MasonII/III radial head fractures without the neck involvement treated with pre-curved metacarpal plates. Methods Ninety cases of Mason typeII/III radial head fractures without the neck involvement were retrospectively collected from the department of orthopaedics of our hospital from September 2015 to May 2021. Group A (n = 44) underwent open reduction and internal fixation with pre-curved metacarpal plate, and Group B (n = 46) were fixed by traditional T-shaped plates. The operation time and the incision length were recorded during the operation. The Mayo Elbow Performance Score (MEPS), Disability of Arm, Shoulder and Hand (DASH) score, visual analogue scale (VAS) for pain, range of motion (ROM) and post-operative complications were evaluated at the last follow-up. Results All the patients were followed up for at least 12 months. There were no significant difference between two groups regarding operation time (54.2 ± 12.1 v.s 51.3 ± 7.2, mins), MEPS (88.9 ± 4.2 v.s 87.8 ± 4.4), DASH score (7.3 ± 4.6 v.s 9.0 ± 4.0), VAS (1.6 ± 0.8 v.s 1.7 ± 0.7), and ROM. However, the incision length was shorter in Group A (5.6 ± 0.5 v.s 6.6 ± 0.5, cm, P < 0.01). The postoperative complication rate was also lower in Group A (1/44 v.s 8/46, P = 0.02). Conclusion Masson II/III radial head fractures without the neck involvement treated with pre-curved metacarpal plates could achieve satisfactory outcomes comparable to traditional T-shaped plates. Moreover, the invasiveness and postoperative complications are less in patients with pre-curved metacarpal plates. Level of evidence III, retrospective comparison study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of radial head fractures treated with pre-curved metacarpal plate

Yang,

Zhuang,

Xiaosong

et al. 2023

BMC Musculoskelet Disord

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“…Nevertheless, in our series only two patients (12.5%) treated with RHR required a revision to prosthesis for instability to stress in valgus. Also, ORIF may present complications such as nonunion and osteoarthritis [ 29 ]. In our ORIF series, many complications have occurred and the 50% of patients underwent a prosthetic revision.…”

Section: Discussionmentioning

confidence: 99%

Mason type III fractures of the radial head: ORIF, resection or prosthetic replacement?

et al. 2022

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Purpose This study focused on a comparison of mid-term clinical, functional and radiographic outcomes of adults treated by open reduction and internal fixation (ORIF), radial head prosthesis (RHP) and resection (RHR). Methods The retrospective evaluation concerned 47 surgically treated patients after a mean follow-up of 53 months. All patients were grouped according to the surgical procedure performed: 15 in the RHP group, 16 in the ORIF group and 16 in the RHR group. At the follow-up, outcome assessment was based on radiographs, range of motion (ROM) and functional rating scores. Results Patients treated by RHR had significantly higher mean age and shorter operation time than other two groups. Compared to ROM, flexion, extension and pronation were significantly worse in patients treated by ORIF than those in the RHP group and the RHR group. Supination was significantly better in the RHP group. However, no statistical differences were observed in functional rating scores among the three groups. Regarding complications, instability was the only cause of revision surgery in the RHP group and the RHR group. On the other hand, the ORIF group revision rate was 50% and secondary displacement was the most frequent cause of failure. Conclusion The ORIF group did not show good results with greater elbow stiffness and higher revision rate than the other two techniques. RHR may be suitable for elderly patients with lower functional demands as it reported good clinical results and reduced operation time.

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“…Functional outcomes were equal or superior as compared to plate fixation. Nonunions were frequently observed, but asymptomatic, and rates of development of osteoarthritis were seen in the majority of patients in both groups (55). The implant to be removed in 54% of the plate fixation group (56).…”

Section: Treatment Of Displaced (>2 Mm) Fracture Of the Radial Head O...mentioning

confidence: 99%

“…The risk for avascular necrosis is low, and the bone healing rate is high (52,53,54). Two small retrospective studies reported that preserving the patient's own radial head with screws in comminuted fractures without subsequent fixation of the head to the radial shaft might be a good alternative to plate fixation (55,56). Functional outcomes were equal or superior as compared to plate fixation.…”

Section: Treatment Of Displaced (>2 Mm) Fracture Of the Radial Head O...mentioning

confidence: 99%

Which radial head fractures are best treated surgically?

Windt,

Langenberg,

Colaris

et al. 2024

EFORT Open Reviews

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Despite the common occurrence of radial head fractures, there is still a lack of consensus on which radial head fractures should be treated surgically. The radial head is an important secondary stabilizer in almost all directions. An insufficient radial head can lead to increased instability in varus–valgus and posterolateral rotatory directions, especially in a ligament-deficient elbow. The decision to perform surgery is often not dictated by the fracture pattern alone but also by the presence of associated injury. Comminution of the radial head and complete loss of cortical contact of at least one fracture fragment are associated with a high occurrence of associated injuries. Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. Displacement (>2 mm) of fragments in radial head fractures without a mechanical block to pronation/supination is not a clear indication for surgery. Mechanical block to pronation/supination and comminution of the fracture are indications for surgery. The following paper reviews the current literature and provides state-of-the-art guidance on which radial head fractures should be treated surgically.

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Preserving the radial head in comminuted Mason type III fractures without fixation to the radial shaft: a mid-term clinical and radiographic follow-up study

Cited by 9 publications

References 55 publications

Outcomes of radial head fractures treated with pre-curved metacarpal plate

Outcomes of radial head fractures treated with pre-curved metacarpal plate

Mason type III fractures of the radial head: ORIF, resection or prosthetic replacement?

Which radial head fractures are best treated surgically?

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