Résultats de l’arthroplastie de la tête radiale implantée en press-fit après fracture complexe de la tête radiale

Abstract

IntroductionPress-fit radial head arthroplasty (RHA) is increasingly popular in treating complex radial head fractures. This study assessed the outcome of RHA, including the outcome following re-operation, and explored potentially influencing factors. HypothesisComplex radial head fractures treated with press-fit radial head prosthesis would have a favorable outcome. Material and methodsData on all consecutive patients treated with anatomic press-fit RHA from February 2002 to February 2015 were analyzed. Post-surgery clinical and x-rays assessments included a post-discharge evaluation of function. Standardized methods implemented include the assessment of range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and subjective satisfaction scales. ResultsForty-five patients were recruited and 71 % were classified in Mason IV and 62.2 % had the “terrible triad”. Re-operation was performed in 26.7 % and prosthesis removal in 15.6 %. Mean follow-up was 140.8 months (95 % CI 117.7-164) and prosthesis survival was 69.5 % at 24 months. Mean MEPS before re-operations was 86.3±15.9. Pain and/or instability were the most common reasons for re-operation, and re-operations were significantly more frequent in patients having one or more “associated injuries” (p=0.05), but not the terrible triad; and in patients with radiological ‘loosening’ signs (p<0.01). Subjective scores were relatively good in most patients, although the functionality perceived in the re-operation with implant removal group was rather low. DiscussionSeveral studies of complex radial head fractures treated with press-fit radial head prosthesis have also shown favorable results, but the patients in such studies generally had less severe lesions. Moreover, differently from previous reports, this study with a long follow-up has included a younger population with high functionality requirements. Pain and/or instability, as observed in several previous reports, were the most common reasons for re-operation, but contrary to the expectation, the terrible triad was not associated with unfavorable outcome. ConclusionTreatment of complex fractures with press-fit radial head prosthesis, including re-operation with implant removal yields satisfactory results. Most scores of functional and subjective outcome improved following the re-intervention and most patients returned to their usual occupation. Level of evidenceLevel IV; Case Series; Treatment Study.