The effect of fracture comminution on the reliability and accuracy of radial head sizing

Abdulla, Irfan; Langohr, G. Daniel G.; Gladwell, Michael; Yeung, Celine; Faber, Kenneth J.; King, Graham J.W.; Athwal, George S.

doi:10.1016/j.jse.2014.10.026

Cited by 14 publications

(6 citation statements)

References 12 publications

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“…By averaging minimum and maximum diameters, the radial head diameter can be better approximated with a maximum difference of 1.0 mm compared to 3D-based diameter. The manual measurements of minimum and maximum diameters showed very high interobserver agreement, which is consistent with previous findings [4]. …”

Section: Discussionsupporting

confidence: 91%

“…They usually change with diameter increments of 2 mm [4, 16]. An important aspect in choosing implant size is estimating the native radial head diameter [4]. When using the contralateral side as reference, presence of sufficient anatomical bilateral symmetry is a prerequisite.…”

Section: Discussionmentioning

confidence: 99%

“…Recent research focused on methods for predicting the native diameter of injured radial heads, as reference for implant selection [4–6]. Alolabi et al [5] stated that the excised radial head, when available, should be used to select the implant.…”

Section: Introductionmentioning

confidence: 99%

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Validation of the contralateral side as reference for selecting radial head implant sizes

et al. 2016

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PurposeIn arthroplasty of comminuted radial head fractures, the contralateral radial head diameter can be used as reference for implant selection. However, potential bilateral asymmetry may result in a mismatch of the implant with the native bone. Therefore, our purpose was to evaluate anatomical right-to-left differences of radial head diameters. We also compared conventional two-dimensional (2D) with three-dimensional (3D) measurements.MethodsWe used bilateral CT-scans from 25 intact proximal radius pairs of right-handed adult subjects to obtain 50 3D radial head models. After contralateral matching, diameters were calculated using a 3D-based method using an automated circle-fit in standardized cross-sections at the widest level midway through the radial head. The 3D-based diameters were compared to orthogonal line measurements in standard axial CT-slices.ResultsThree-dimensional analysis yielded a radial head diameter of 23.0 ± 1.7 mm. The dominant right side was significantly wider, with right-to-left differences of 0.2 ± 0.4 mm, with a maximum of 0.9 mm. The 2D-based diameter was 22.9 ± 1.7 mm, which was 0.1 ± 0.3 mm smaller compared to corresponding 3D-based diameter.ConclusionsIn healthy radial heads, the diameter was biased to the dominant right side, but individual differences were not larger than 1 mm. Compared to implant designs, in which diameter increments are usually 2 mm, this right-bias is not clinically relevant, as it would not affect implant selection. Therefore, the contralateral side can be considered a suitable reference. In clinical practice, the surgeon could estimate this diameter using standard axial CT slices, since its difference with the 3D-based evaluation was also relatively small compared to implant sizing increments.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Validation of the contralateral side as reference for selecting radial head implant sizes

et al. 2016

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“…Subsequently, the Rh maximum diameters were first estimated with dedicated sizing dish with circular cutouts and then measured with a graduated calliper; similarly, the minimum diameters were measured with a graduated calliper. Two Rhs were then fractured to simulate a three-fragment fracture (A) and a four-fragment fracture (B) as previously described by Abdulla et al [ 21 ]; the third Rh was fractured to simulate an extremely comminuted pattern (C); the last one was prepared to simulate a comminuted fracture with bone loss (D) (Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Although several biomechanical and clinical studies exists, suggesting how to appropriately choose the implant size for a RhR, to our knowledge only one study has evaluated the effect of fracture comminution on the radial head measurement accuracy [ 21 ] and no studies have investigated how different surgeons would approach the same fracture and how the fracture pattern may influence their operative choices.…”

Section: Introductionmentioning

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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Radial head arthroplasty diameter impact on elbow kinematics evaluated by dynamic radiostereometric analysis

Teilmann,

Petersen,

Thillemann

et al. 2024

J. exp. orthop.

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PurposeRadial head arthroplasty (RHA) reestablishes elbow stability after complex radial head fracture, but complication rates are high, possibly due to inappropriate implant sizing. Knowledge of impact of radial head implant diameter on elbow kinematics is limited and warranted. This study evaluated elbow kinematics of different radial head implant diameters after RHA using dynamic radiostereometric analysis (dRSA).MethodsEight human donor arms were examined with dRSA during elbow flexion with the forearm in unloaded neutral position, and in supinated‐ and pronated position without and with 10N either varus or valgus load, respectively. Elbow kinematics were examined before and after RHA with head diameters of anatomical size, −2 mm (undersized), and +2 mm (oversized). The ligaments were kept intact by use of step‐cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from CT, and by AutoRSA software bone models were matched with dRSA recordings. The elbow kinematics were described using anatomical coordinate systems.ResultsCompared to the native radial head during elbow flexion, the anatomical sized RHA shifted 2.0 mm in ulnar direction during unloaded pronated forearm position. The undersized RHA shifted 1.5 mm in posterior direction and 2.1 mm in ulnar direction during unloaded pronated forearm position and increased the varus angle by 2.4° during supinated loaded forearm position. The oversized RHA shifted 1.6 mm in radial direction during loaded supinated forearm position.ConclusionsThe anatomically sized RHA should be preferred as it maintained native elbow kinematics the best. The kinematic changes with oversized and undersized RHA diameters were small, suggesting forgiveness for the RHA diameter size.Level of EvidenceLevel III.

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The effect of fracture comminution on the reliability and accuracy of radial head sizing

Cited by 14 publications

References 12 publications

Validation of the contralateral side as reference for selecting radial head implant sizes

Validation of the contralateral side as reference for selecting radial head implant sizes

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

Radial head arthroplasty diameter impact on elbow kinematics evaluated by dynamic radiostereometric analysis

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