The Functional Outcome with Metallic Radial Head Implants in the Treatment of Unstable Elbow Fractures: A Long-Term Review

Harrington, Ian J.; Sekyi-Otu, Ato; Barrington, T W; Evans, D. C.; Tuli, Vikas

doi:10.1097/00005373-200101000-00009

Cited by 250 publications

(165 citation statements)

References 15 publications

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“…First, removal of the radial head for planned arthroplasty allows for better visualization of the coronoid fracture fragment. The importance of adequate coronoid fixation in terrible triad injuries has been documented previously [5,7,8,11,21]. Improved visualization through the existing lateral incision may potentially allow for better reduction and fixation, regardless of fixation technique.…”

Section: Discussionmentioning

confidence: 94%

“…Radial head arthroplasty has been shown to be a reliable technique for reconstruction of the radial head [8,16]. While potentially confounded by the fact that the radial head fractures selected for arthroplasty tend to result from higher-energy injuries with more comminution, the radial head prostheses interestingly were more stable and had a greater ROM when compared to ORIF.…”

Section: Discussionmentioning

confidence: 99%

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Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Watters

Garrigues

Ring

et al. 2014

Clinical Orthopaedics &Amp; Related Research

110

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Background Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. Specifically, the question of whether to repair or replace the radial head remains controversial. Questions/purposes We compared patients with terrible triad injuries of the elbow whose radial head fracture was treated with either internal fixation and internal fixation (ORIF) or radial head arthroplasty in terms of (1) clinical outcome measures (DASH and Broberg-Morrey scores, ROM), (2) elbow stability and radiographic signs of arthrosis, and (3) complications and reoperation rates. Methods Retrospective review identified 39 patients with terrible triad injuries and minimum 18-month complete clinical and radiographic followup (mean, 24 months; range, 18-53 months). Patients were managed with a standard algorithm consisting of (1) repair (n = 9) or replacement (n = 30) of the radial head, (2) repair of the lateral ulnar collateral ligament, and (3) repair of the coronoid fracture. During the study period, the radial head generally was internally fixed when there were fewer than four articular fragments; otherwise, it was replaced. Evaluation included the DASH score, the Broberg-Morrey index, measurements of elbow stability and motion, and radiographic assessment for signs of arthrosis; chart review was performed for complications and reoperations. Complete followup was available on 87% (39 of 45 patients).

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Watters

Garrigues

Ring

et al. 2014

Clinical Orthopaedics &Amp; Related Research

110

View full text Add to dashboard Cite

show abstract

“…A metal radial head replacement restored elbow stability when fracture of the radial head occurred in combination with dislocation of the elbow, rupture of the medial collateral ligament, fracture of the proximal ulna, and/or fracture of the coronoid process. Clinical results suggest that this functions well on a long-term basis [8]. The patients' pre-existing wrist pain disappeared after insertion of the radial head prosthesis, suggesting that the radial head prosthesis can restore the anatomical structure of ulnoradial joint and improve function of wrist joint [15].…”

Section: Discussionmentioning

confidence: 99%

A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III

Ruan¹,

Fan²,

Liu³

et al. 2007

International Orthopaedics (SICO

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Although several treatment options for radial head fractures are available, no clear solutions exist. In this study we therefore compare open reduction and internal fixation (ORIF) with bipolar radial head prosthesis replacement in treatment of radial head fractures of Mason type III. Cement stem and bipolar radial prosthesis were used to treat 12 fresh cases and two old cases of Mason type III radial head fracture. As a control group, another eight cases of radial head type III fracture were treated with ORIF with cannulated screws and Kirschner (K) wires. The 14 patients who received radial head prosthesis replacement were followed-up for 15.9 months (range 10-27 months). According to elbow functional evaluation criteria by Broberg and Morrey, we found excellent results in nine cases, good in four, and fair in one. Mean follow-up of the eight cases in the ORIF group was 14 months (range 10-21 months), with good results in one case, fair in four, and poor in three. The result was good or excellent in 92.9% of prosthesis replacement patients and in 12.5% of ORIF patients. This difference is statistically significant (P=0.0004; Fisher's exact test). We concluded that bipolar radial head prosthesis replacement is better than ORIF in treatment of Mason type III radial head fracture.

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“…Remaining instability and pain after primary radial head resection and post-traumatic arthrosis, deformation and non-union may require secondary implantation. Modular monopolar and cemented bipolar metal RHP are the most frequently implanted types [7,10]. Despite predominantly good clinical results, dislocation of components, implant loosening, overstuffing and radiocapitellar arthritis regularly lead to removal and revision.…”

Section: Introductionmentioning

confidence: 99%

“…Few clinical results of modern press-fit metal RHP are described in the literature [10]. The purpose of this study was to evaluate the results after primary and secondary implantation of a newly designed monobloc monopolar type of RHP with a partially grit-blasted, roughened surface conical stem in complex elbow injuries.…”

Section: Introductionmentioning

confidence: 99%

Monobloc radial head prostheses in complex elbow injuries: results after primary and secondary implantation

Katthagen

Jensen

Lill

et al. 2012

International Orthopaedics (SICOT)

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Purpose Dislocations of components, loosening of the stem, overstuffing and removal in up to 24 % of common radial head prostheses (RHP) after implantation in complex elbow injuries signal the need for improvement. The latest biomechanical evidence shows advantages for monopolar designs. Clinical results after primary and secondary implantation of the newly designed press-fit monobloc monopolar RHP in cases of complex elbow injury are evaluated. Methods Twenty-nine patients [median age 60 years (29-86)] were followed up retrospectively for a median of 25 months (7-54) post-operatively. Subjective parameters, the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey score (BMS), latest radiographs and complications were evaluated. Results MEPS and BMS averaged 87.2±12.9 and 81.1±11.9 points, respectively. No case of implant loosening was observed; the RHP had to be removed in one case (3 %). The overall complication and revision rate was higher after secondary (53 %) than after primary (19 %) implantation. Conclusions Satisfactory clinical results and low short-term removal rates emphasise the practicality of monobloc monopolar RHP. Differentiated treatment of complex elbow fracturedislocations is compulsory to avoid the need for secondary RHP implantation which carries a higher complication rate.

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The Functional Outcome with Metallic Radial Head Implants in the Treatment of Unstable Elbow Fractures: A Long-Term Review

Abstract: We conclude that a metal radial head prosthesis has select indications. We advocate its use when the radial head cannot be reconstructed in the setting of a clinically unstable elbow. Results suggest that it functions well on a long-term basis.

Cited by 250 publications

References 15 publications

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III

Monobloc radial head prostheses in complex elbow injuries: results after primary and secondary implantation

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