Partial allograft replacement of the radial head in the management of complex fracture-dislocations of the elbow

Abstract

There have been reports of total radial head allografts showing variable outcomes. This case series reports the novel use of an allograft for partial radial head replacement in the treatment of elbow fracture-dislocation. Eight patients underwent partial radial head allograft reconstruction to restore stability for complex fracture-dislocations involving fractures of the coronoid and radial head, with collateral ligament disruption. Two patients were treated acutely. Six were referred from other centers 2 to 48 weeks after injury following failure of primary treatment. In each case, it was not possible to perform stable open reduction-internal reduction of the radial head fracture, or the fracture fragment had already been excised. A fresh-frozen partial radial head allograft was used to replace the defect and restore the joint surface. The coronoid fracture and injury to collateral ligaments were also managed surgically. Patient charts, surgical records, and radiographs were reviewed. Patients were contacted at a mean of 79 months after treatment to answer questions to determine the Mayo Elbow Performance Score and the score on the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Clinical and radiologic reviews confirmed union of graft in all cases. None resorbed or collapsed. Three patients had resorption of the coronoid fragment resulting in poor outcomes, with one patient ultimately undergoing total elbow arthroplasty. Partial radial head allograft may be a useful alternative to radial head prosthesis in unstable fracture-dislocations in which the radial head cannot be restored fully.