The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

Abstract

Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% ( p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% ( p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% ( p < 0.001) of the CR and in 18% ( p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% ( p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.

Elbow Arthroscopy for the Treatment of Radial Head Fractures: Surgical Technique and 10 Years of Follow Up Results Compared to Open Surgery

“…Wang et al [ 27 ] reported results from 18 cases with Mason type II fractures treated with percutaneous K-wires under arthroscopy with clinical good results. In 2019, Haasters et al [ 28 ] reported a retrospective case series of 20 patients, highlighting good results and a high capacity of arthroscopy to diagnose and treat concomitant elbow injuries that might not be visible at MRI or CT scan.…”

Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study

“…Previous studies [ 6 , 7 , 24 ] have demonstrated that the radial nerve is prone to injury during the anterolateral approach in elbow arthroscopy. The radial nerve is directly anterior to the radial head, and the anterolateral portal is located anterior to the articulation of the humeroradial joint [ 25 ].…”

Radial head fractures

“…The fractures were fixed with 2 mm screws or underwent partial resection, with mobilisation commencing at day 1 post-operatively. 10 Arthroscopy also detects a high rate of missed osteochondral lesions, loose bodies, and ligamentous instability, when compared to imaging and clinical findings. 11…”