Replacement of the comminuted radial head fracture by a bipolar radial head prosthesis

Müller, Marcus; Burger, C.; Wirtz, Dieter Christian; Weber, O.

doi:10.1007/s00064-010-0004-8

Cited by 9 publications

(1 citation statement)

References 25 publications

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“…The relationship between the trial implant and intra-operative anatomical landmarks may also help in identifying the correct Rh size. Doornberg et al [ 13 ] found on CT reconstruction that the lateral edge of the coronoid articular surface is a reproducible landmark, and suggested to place the articular surface of the implant slightly more proximal than this landmark, whereas Müller et al [ 40 ] used trial stems to determine the size of the implant and concluded recommending to obtain 0.5 mm between the head of the replacement and the capitulum humeri. The lesser sigmoid notch of the ulna, which has been demonstrated to be a reproducible landmark to choose the implant height [ 41 ], has also been proposed as a possible landmark to assist in choosing the correct Rh diameter, but has been associated to poor interobserver reliability both intra-operatively and on preoperative CT scans [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Fracture Pattern Influences Radial Head Replacement Size Determination Among Experienced Elbow Surgeons

Cucchi

Luceri

Celli

et al. 2020

IJOO

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Background Correct sizing is challenging in radial head replacement and no consensus exists on the implant’s optimal height and width to avoid elbow stiffness and instability. Studies exists, suggesting how to appropriately choose the implant size, but the manner by which the fracture pattern influences the surgeons’ operative choices was not investigated. Methods The radial heads of four fresh-frozen cadaveric specimens were excised, measured, and fractured to simulate four patterns: three fragments (A); four fragments (B); comminuted (C); comminuted with bone loss (D). Nine examiners were asked to indicate first the maximum diameter of the radial heads with the help of dedicated sizing dishes and then the appropriate implant size with trial implants. Accuracy and precision were determined. A coefficient of variation was calculated and agreement was evaluated with the Bland–Altman method. Results Accuracy and precision of radial head diameter estimation with dedicated sizing dish were 96.73% and 93.64%, (best pattern, D; worst, C). Accuracy and precision of radial head diameter estimation with trial implants were 99.71% and 90.66% (best pattern, A; worst, D). Frequent modifications occurred between the initial radial head size proposal based on the sizing dish and the radial head size chosen after use of the trial implants (47.2%). Conclusions Diameter estimation of radial heads with dedicated sizing dishes may be underestimated in comminuted fractures; when bone loss is present, this may lead to an overestimation, especially when using trial implants. Care is essential to determine the optimal size of the implant and to avoid overlenghtening and oversizing, which can be responsible for implant failure. Level of Evidence Basic Science Study. Clinical Relevance Knowledge of the manner by which the fracture pattern influences radial head replacement size estimation can help preventing overlenghtening and oversizing during this procedure.

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Section: Discussionmentioning

confidence: 99%