Abstract
Background/purposeRadial head replacement is frequently used in treatment of radial head fractures or sequela. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications. The authors describe their case studies and results on the implantation of various radial head prostheses.MaterialsBetween June 2005 and June 2016, 28 radial head prostheses were implanted in the same number of patients with an average follow-up of 49 months (6–104). Indications for implantation were: Mason type III and IV radial head fractures and post-traumatic arthritis due to failure of previous treatments. Monopolar prostheses were used and were press-fit implanted via Kaplan’s lateral access and Kocher’s anconeus approach to the humeroradial joint. At the follow-up, assessments were made of the pain, according to the visual analogic scale, range of motion (ROM), stability and functionality according to the Mayo Elbow Performance Score, presence of osteolysis and mobilization during radiography tests, personal satisfaction of the patients, Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation outcomes measurements.ResultsAt the follow-up, we recorded an average level of pain of 1.8 in patients under acute treatments for radial head fractures and a marked reduction in the remaining cases from 6.7 to 2.1. ROM was found on average to be 107° of flexion–extension and 159° of pronosupination. Personal satisfaction was good–excellent in 23 cases. There was no case of infection; removal of the implant was necessary in three cases due to mobilization of the stem and oversized implants. In six cases, bone resorption was seen at the level of the prosthetic collar and it was in all cases asymptomatic.ConclusionsThe results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life.
Highlights
The results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life
According to studies by the Mayo Foundation, the medial collateral ligament (MCL) is the primary stabilizer of the elbow joint and the radial head is second in importance in the stabilization during loading and valgus stress [3]
At the follow-up, assessments were made of the pain, according to the visual analogic scale (VAS), the range of motion (ROM), the stability and functionality according to the Mayo Elbow Performance Score (MEPS), the presence of osteolysis and mobilization of the implant during radiographic tests, the personal satisfaction of the patients according to four grades, the Disability of Arm Shoulder and Hand (DASH) score and the Patient-Rated Wrist Evaluation (PRWE) score
Summary
The humeroradial joint is the lateral column of the elbow and is an important stabilizer for axial and valgus loading [1].Its integrity ensures good stability of the elbow even in the presence of other lesions, such as lesion of the medial collateral ligament (MCL) or minor coronoid fractures.Fractures of the radial head constitute 1.7–5.4% of upper limb fractures and 33–75% of all elbow fractures [2] and are often associated with complex lesions that affect the medial compartment or coronoid.According to studies by the Mayo Foundation, the MCL is the primary stabilizer of the elbow joint and the radial head is second in importance in the stabilization during loading and valgus stress [3].1 3 Vol.:(0123456789) S198Musculoskelet Surg (2017) 101 (Suppl 2):S197–S204from the biomechanical point of view, in the presence of injury of the MCL, coronoid fracture or lesions of the lateral collateral ulnar ligament (LUCL), the radial head is considered a structure of fundamental importance [4].In many works, the results and limits of radial head excision are described in the treatment of complex fractures that lead, in the long term, to valgus instability, longitudinal instability with positive ulnar variance and pain in the wrist, lack of strength and the appearance of ulnohumeral degenerative changes [5, 6].It is agreed that the indications for radial head excision are isolated comminuted fractures of the radial head without signs of longitudinal or medial instability in elderly or low demanding patients [7,8,9,10,11]. The humeroradial joint is the lateral column of the elbow and is an important stabilizer for axial and valgus loading [1]. Its integrity ensures good stability of the elbow even in the presence of other lesions, such as lesion of the medial collateral ligament (MCL) or minor coronoid fractures. According to studies by the Mayo Foundation, the MCL is the primary stabilizer of the elbow joint and the radial head is second in importance in the stabilization during loading and valgus stress [3]. From the biomechanical point of view, in the presence of injury of the MCL, coronoid fracture or lesions of the lateral collateral ulnar ligament (LUCL), the radial head is considered a structure of fundamental importance [4].
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