Mason Type Research Articles

Short- to Mid-term Results of Patient-Specific Polymethylmethacrylate Radial Head Prosthesis in Complex Radial Head Fractures Using 3-Dimensional Mold System.

Background: We used antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement to make a patient-specific radial head prosthesis (RHP) by applying the 3-dimensional (3D) designing technique in patients with Mason types 3 and 4 radial head fractures. The aim of this study is to report the short- to mid-term outcomes of this procedure. Methods: This is a prospective study of all patients who underwent a patient-specific PMMA bone cement RHP at our institute over a 1-year period from May 2017 to June 2018. The outcome measures included range of motion, grip strength, visual analogue scale (VAS) for pain at rest and at activity, disabilities of arm, shoulder and hand (DASH) score and Mayo elbow performance index (MEPI). Radiographs of the elbow ere obtained at final follow-up and any complications were also recorded. Results: Our study included eight patients with a mean follow-up of 18 months (13-20 months). The mean arc of extension-flexion and supination-pronation of the operated side was 86% and 96% of the unaffected side, respectively. Mean grip strength was 86% of the unaffected side. The mean VAS for pain at rest was 0 and during activity was 2 out of 10. The mean DASH score was 8 out of 100 (0-22), showing minimal disability and ability to cope with most living activities. MEPI showed four excellent, three good and one fair result. One patient complained of proximal forearm pain that appeared 1 year after surgery. No patient complained of ulnar nerve symptoms requiring intervention. No RHP was removed during the follow-up. Conclusions: PMMA RHP can be used safely as an alternative to metal prostheses to restore valgus and axial stability of the forearm. The use of 3D printing optimised the design and surgical technique of radial head arthroplasty, and we need further studies to assess the long-term follow-ups. Level of Evidence: Level IV (Therapeutic).

Percutaneous elevation of radial head fractures without fixation – a promising technique

In Mason type II radial head fractures surgical treatment is recommended. A promising technique is percutaneous elevation for depressed monofragmentary articular surface fractures. This study aimed to investigate the radiographic outcome, complication and revision rate following percutaneous radial head reduction without fixation in Mason type II fractures. A retrospective study was performed between 2016 and 2021. Data on demographics, dislocation in mm based on pre, one week and at least 6 weeks post-operative x-rays as well as complications including revision surgery were noted. In all patients a 2.0mm K-wire was used as metal bone tamps to reduce the fracture under imaging intensifier until no step was identifiable following an immobilization in a backslap for a week. If no secondary dislocation was noted patients were allowed to actively move the elbow. In 36 patients at a mean age of 38.6±10.7years a percutaneous elevation was performed. The mean displacement at time of initial presentation was 2.2±1.1mm on Coyle and on lateral view 1.2±1.0mm. At initial and final follow up (9.3±2.1days, respectively 64.6±180.8days), the fracture gap was reduced with a displacement of 0.2±0.6mm on Coyle view, respectively 0.2±0.5mm, and 0.3±0.5mm, respectively 0.1±0.3mm on lateral view (p<0.005). The mean surgical time was 14.8±12.2minutes and no complication nor secondary fracture dislocation was observed. This study shows that percutaneous closed reduction without fixation in Mason type II fractures is a very effective technique with a short surgical time and no complications if patients are selected correctly. Level of evidence: Level III, retrospective trial

A COMPARATIVE STUDY BETWEEN FUNCTIONAL OUTCOME OF RESECTION AND RECONSTRUCTION OF RADIAL HEAD FRACTURES

Background: Fractures of the radial head are most commonly undiagnosed among elbow fractures. Complications can occur if management is delayed or neglected. Though the management of these fractures has improved a lot, it still has a learning curve. 29 patients were divided Materials and Methods: into two groups Group A (17 patients) operated with excision and Group B (12 patients) treated with reconstruction. Follow up was done at regular intervals and post operative clinical assessment was done using Broberg and Morrey rating system Results and Conclusion: Out of these two procedures, the difference in Broberg and Morrey score was not signicant. But it was seen that in patients with Mason type II reconstruction showed better results than resection. In Mason III fractures, due to difculty in achieving anatomical reduction, results were not good with reconstruction when compared with resection

RADIAL HEAD FRACTURES, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Introduction: In recent years the understanding and comprehension of the elbow has improved, clarifying some aspects of the complex diarthrodial joint. The relevance of the radial head in the biomechanics of the elbow is recognized which helps to improve the management and treatment of fractures at this site. Elbow trauma is the most common origin of proximal radius fractures, this trauma can be direct or indirect and can cause an isolated fracture, a fracture associated with other fractures and ligament injuries. Objective: to detail the current information related to radial head fractures, epidemiology, anatomy, presentation, clinical evaluation, imaging evaluation, classification, treatment and complications. Methodology: a total of 42 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 31 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: radial head fractures, radial head prosthesis, radial head arthroplasty. Results: Radial head fractures have an incidence of 2.5 per 10,000 per year, which represents 1.7 to 5.4% of all fractures. Most radial head injuries are the result of a fall on the hand in extension. Usually the affected individuals show limitation of mobility of the forearm and elbow in addition to pain or discomfort when making passive rotational movement of the forearm; they also usually present pain on palpation over the radial head and joint effusion in the elbow. Sometimes there is a fracture-dislocation of the radial head related to a rupture of the interosseous membrane with lesion of the distal radioulnar joint called Essex-Lopresti lesion. Conclusions: The radial head together with the interosseous membrane of the forearm provide longitudinal stability; when the interosseous membrane is damaged, a proximal migration of the radial head may occur after removal of the radial head. When presenting clinical suspicion of elbow fracture, standard anteroposterior and lateral projections of the elbow should be requested, as well as oblique projections such as the Greenspan projection. The Manson, Mason-Johnston or Mason classification modified by Hotchkiss is usually used for classification. Among the indications for conservative treatment are solitary, undisplaced or minimally displaced fractures that do not present mechanical blockages in the range of motion or less than 3 mm of displacement. Studies report the effectiveness of open reduction and internal fixation of simple Mason type II fractures; Manson type III fractures are controversial. Complications usually arise from contracture subsequent to prolonged immobilization or secondary to persistent pain, edema and swelling; which may be due to undiagnosed osteochondral injury of the capitellum. KEY WORDS: fracture, radius, head, prosthesis, elbow.

90-day outcomes and factors for complications following radial head arthroplasty for Mason Type III and IV radial head fractures.

The aim of this study is to evaluate 90-day outcomes and complications following radial head arthroplasty (RHA) for Mason Type III and IV radial head fractures (RHFs) and determine factors predisposing patients to early complications and revision surgery. Patients undergoing RHA for Mason Type III and IV RHFs were identified retrospectively from an institutional database. Postoperative complications, reoperations, elbow range of motion, radiographs and concomitant injuries on the ipsilateral upper extremity were reviewed. Additionally, injuries were sub-classified as low-energy trauma (LET) or high-energy trauma (HET). Univariate logistic regression was performed to evaluate the risk for complications using patient factors not limited to the presence of concomitant ligamentous or bony injuries. P values < 0.05 were considered statistically significant. Seventy four patients were included in our study with an average follow-up time of 12.7months. Complications within 90-days of operation occurred in 8.1% of patients: heterotopic ossification (4.1%), superficial wound dehiscence (2.7%), and posterior interosseous nerve palsy (1.4%). No patients required readmission or revision surgery in the 90-day postoperative period. Univariate regression analysis did not demonstrate a significant association between diabetes, ASA status, HET versus LET, or the presence of concomitant injury. Concomitant injuries were found in 92% of patients. Radial head arthroplasty for RHFs demonstrates a low complication rate in the short-term. Diabetes, ASA class, high versus low energy trauma, and presence of concomitant injury were not found to be associated with higher complication rates in the 90-day postoperative period. Level of evidence IV, retrospective case series.

Results of the Use of Bioabsorbable Magnesium Screws for Surgical Treatment of Mason Type II Radial Head Fractures.

In Mason classification type II radial head fractures, compared to plate fixation, fixation with cannulated headless screws and absorbable pins has been reported to provide more favorable postoperative outcomes, including less postoperative limitation in range of motion. The fact that radial head fractures are less prone to weight-bearing during fracture union further supports the use of absorbable screws as a suitable alternative treatment option in radial head fractures. This study aimed to perform fixation through open reduction using bioabsorbable magnesium screws for Mason type II radial head fractures and to report radiographic and clinical results. Among patients who visited the orthopedic department from April 2017 to August 2021, 22 with surgical indications were selected for participation. Radiographic tests were conducted at 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, and over 1 year after surgery to confirm the degree of bone union, reduction loss, and degree of H2 gas production. The Disabilities of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), hand grip power, and range of joint motion were measured at the 6-month follow-up to evaluate the clinical efficacy of the operation. Bone union was confirmed in all 22 cases, and the mean time to union was 10.2 weeks. DASH score was 22.27 on average and no patients complained of significant discomfort after the surgery. The mean MEPS was 91.1. The hand grip power of the affected hand was similar to that of the unaffected hand, being 1.19% weaker on average. These differences reached statistical significance (p = 0.002). The range of elbow joint motion was measured: mean flexion, 146.1°; mean extension, 1.4°; mean pronation, 88.2°; and mean supination, 87.9°. In treating Mason type II radial head fractures, the use of bioabsorbable screws made of magnesium showed satisfactory results in radiographic and clinical evaluations. Magnesium bioabsorbable screws can maintain sufficient stability at the fracture site and have the advantage of avoiding secondary operation for the removal of internal fixation devices.

Incidence and pattern of concurrent capitellum fracture associated with radial head and neck fractures

BackgroundRadial head and neck fracture is a common fracture around the elbow. It is mostly caused by axial or valgus loading after a fall in elbow extension and forearm pronation. When a radial head and neck fracture occurs, the capitellum collides with the radial head and experiences a shear force, leading to capitellum fracture. The primary aim of this study was to evaluate the incidence of concurrent capitellum fracture and analyze its patterns among patients treated for radial head and neck fractures based on computed tomography. Secondary aim is to determine factors associated with concurrent capitellum fractures. HypothesisCapitellum fractures are more common than expected in radial head and neck fractures and show a consistent pattern. With the higher the Mason type fracture, the higher the incidence of concurrent capitellum fracture will be shown. MethodsA total of 101 patients treated surgically (27 patients) or non-surgically (74 patients) for radial head and neck fractures from January 2017 to December 2020 were retrospectively analyzed. Initial computed tomography was reviewed to identify concurrent capitellum fractures. A fracture was diagnosed when the bone continuity was lost in two consecutive images in any one of the three directions of computed tomography scan images. Seventeen patients with capitellum fractures were classified as group 1 and 84 patients without capitellum fractures as group 2. Each group of patients was assessed using Mason classification, whether fracture extended to the radial neck or not, fracture location, and treatment method. To determine the fracture location, radial head was trisected using three anatomical landmarks: safe zone, posteromedial zone, and anteromedial zone. And it was determined as the location where the fracture was most comminuted. ResultsThe average age of the 101 patients was 44.6 years old. There were 54 (53.5%) males and 47 (46.5%) females. Capitellum fracture was accompanied in 17 cases. Its incidence was 16.8%. The rate of accompanying capitellum fracture was 9.5% (6/63) for Mason type 1, 25.0% (6/24) for Mason type 2, and 41.7% (5/12) for Mason type 3. The ratio of radial neck extension of fracture was significantly higher in group 2. There was no isolated radial neck fracture in group 1. However, there were 33 in group 2. After eliminating isolated radial neck fracture patients, significantly more fractures were located in the safety zone in group 1. Group 1 had a significantly higher rate of surgical treatment than group 2 (52.9% (9/17) vs. 21.4% (18/84) p=0.007). ConclusionFor radial head and neck fractures, the higher the Mason type fracture, the higher the incidence of concurrent capitellum fracture. When the fracture extended to the radial neck, the comorbidity of the capitellum fracture was decreased. Among radial head fractures, when the fracture was located in the safe zone, the comorbidity of capitellum fracture was increased. The rate of surgical treatment was higher in radial head and neck fracture patients with concurrent capitellum fractures. Level of evidenceIV; diagnostic study.

The simulation of terrible triad injuries in fresh-frozen human cadaveric specimens with intact soft tissue envelope

IntroductionThe aim of the present study was to develop a technical process to reproducibly generate terrible triad injuries (TTI) in fresh-frozen human cadaveric specimens, while leaving the skin intact. Such “pre-fractured” specimens, used for scientific analysis and for surgical education, might help to improve current treatment, which is complex and prone to complications.Materials and methodsTo induce the desired fractures, a custom-made fracturing unit was used to apply an axial force on the extended cadaveric elbow specimens, with the forearm pronated and under valgus load. To simulate the valgus load, a pneumatic cylinder was developed to apply valgus stress to the joint by an additional force vector from the lateral side of the joint.ResultsThe success rate of TTI induction was 92.3% (12/13). Of the 12 radial head fractures, 3 (25%) were classified Mason type II and 9 (75%) Mason type III. The coronoid fractures were grouped in tip subtype 2 (5 fractures, 41.7%), anteromedial facet (AMF) subtype 2 (4 fractures, 33.3%), AMF subtype 3 (1 fracture, 8.3%) and basal subtype 1 (2 fractures, 16.7%).ConclusionsThe present study provides an instrument for successful and reproducible production of dislocation fracture patterns with their typical accompanying soft tissue lesions. The methodology might be applied on a broad basis to be able to perform biomechanical studies regarding primary stability of fixation concepts for TTI and to educate surgeons in a fairly realistic scenario with the surgical treatment of TTI.

Comparison of open reduction and internal fixation and radial head resection for treatment of Mason type 2 and 3 fractures in young and active patients: our experience

Objective. The management of Mason type II and III radial head fractures (RHF) is still a debated topic. In the past, the only treatment of choice was radial head resection (RHR) but, as surgical techniques and instrumentation have advanced, internal screw fixation (ORIF) has gained popularity. The aim of this paper is to compare in a retrospective analysis the outcomes of ORIF and RHR in these fracture patterns in young patients. Methods. A total of 37 patients (age between 20 and 60 years old) affected by Mason type 2 and 3 RHF and surgically treated were collected by means of our electronic hospital database. Sixteen patients underwent RHR, and 21 patients underwent ORIF with mini screws. Functional outcomes and scores as well as the radiographs were recorded during follow-up. Results. After 22.17 months (range 12-45) of mean follow-up, the mean DASH, UCLA and MEPS scores showed no significant differences between groups (p: 0.26; 0.21; 0.23). The VAS score was unfavorable in the ORIF group compared to the RHR group (p: 0.43) although not statistically significant. Conclusions. The gold standard in the management of these fractures is not universally recognized. The advantages and complications of both techniques as well as of the RH arthroplasty are abundantly described. Our outcomes support RHR as a possible treatment choice in multi-fragmentary fractures of RH in young patients while minimizing complications.

Withdrawn: Percutaneous elevation of radial head fractures without fixation – a promising technique

<h2>Abstract</h2><h3>Introduction</h3> In Mason type II radial head fractures surgical treatment is recommended. A promising technique is percutaneous elevation for depressed monofragmentary articular surface fractures. This study aimed to investigate the radiographic outcome, complication and revision rate following percutaneous radial head reduction without fixation in Mason type II fractures. <h3>Methods</h3> A retrospective study was performed between 2016 and 2021. Data on demographics, dislocation in mm based on pre-, one week and at least 6 weeks postoperative x-rays as well as complications including revision surgery were noted. In all patients a 2.0mm K-wire was used as metal bone tamps to reduce the fracture under imaging intensifier until no step was identifiable following an immobilization in a backslap for a week. If no secondary dislocation was noted patients were allowed to actively move the elbow. <h3>Results</h3> In 36 patients at a mean age of 38.6±10.7years a percutaneous elevation was performed. The mean displacement at time of initial presentation was 2.2±1.1mm on Coyle and on lateral view 1.2±1.0mm. At initial and final follow-up (9.3±2.1days, respectively 64.6±180.8days), the fracture gap was reduced with a displacement of 0.2±0.6mm on Coyle view, respectively 0.2±0.5mm, and 0.3±0.5mm, respectively 0.1±0.3mm on lateral view (p<0.005). The mean surgical time was 14.8±12.2minutes and no complication nor secondary fracture dislocation was observed. <h3>Conclusion</h3> This study shows that percutaneous closed reduction without fixation in Mason type II fractures is a very effective technique with a short surgical time and no complications if patients are selected correctly.

Ex-situ radial head reconstruction with K-wire fixation for mason type-III radial head fracture: A case report

Open Reduction and Internal Fixation (ORIF) with various implants is one of the most commonly used techniques for management of Mason type III radial head fracture; however on-table reconstruction can also be an option where fractures are not amenable to classical ORIF. We present a case of 35 years female with Mason type III radial head fracture who underwent ex-situ radial head reconstruction and fixation with K-wire.

Radial Head Arthroplasty among Patients with Radial Head Fracture in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Proximal radial fractures are a common type of fracture around the elbow joint. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring the stability of the elbow joint and starting early mobilization. The aim of this study was to find out the prevalence of radial head arthroplasty among patients with radial head fracture in a tertiary care centre. A descriptive cross-sectional study was conducted from 25 January 2019 to 25 December 2020 among patients with a radial head fracture at the Department of Orthopaedics of a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee (Reference number: 076/77-08A). A convenience sampling method was used. The study group consisted of patients between 20 to 60 years of age with isolated radial head fractures. Radial head arthroplasty was done for Mason types III and IV fractures and functional outcome was calculated postoperatively with Mayo elbow score on follow-up at 3-, 6- and 12-month intervals. Point estimate and 95% Confidence Interval were calculated. Out of 96 patients with radial head fracture, 22 (22.92%) (17.59-28.25, 95% Confidence Interval) underwent radial head arthroplasty. The mean Mayo elbow score was 96.33±7.74 at 12 months of follow-up. The prevalence of radial head arthroplasty among irreparable radial head fractures was similar compared to other studies done in a similar setting. arthroplasty; elbow prosthesis; radius fractures.

Open Reduction and Internal Fixation of Radial-Head Fractures Mason Type II

Open Reduction and Internal Fixation of Radial-Head Fractures Mason Type II

Radial head fractures: a quantitative analysis.

Several classification systems for radial head fractures discuss the number of fragments and their displacement, but not the exact location. This study aimed to evaluate the location of the radial head fracture fragments and the influence of the Mason type on the size of the fracture fragment. Forty-one radial head fractures (31 Mason type I and 10 type II) with an elliptical radial head were included in this retrospective study and 3D reconstructed. First, the fragments were repositioned to their original location. Next, the orientation of the scanned forearm was evaluated using the position of the longest axis relative to the proximal radio-ulnar joint, and all radial heads were rotated to the neutral rotation. The radial head was divided into 4 quadrants (anteromedial, anterolateral, posteromedial, and posterolateral). The location of the fracture line in correlation with these 4 quadrants was evaluated. All fracture fragments were located in the anteromedial quadrant. Thirty-eight (93%) were located in the anterolateral quadrant. The posterolateral quadrant was involved in 32%. At last, the average fracture fragment size was evaluated according to the Mason classification. A significant difference was found in the average fracture fragment size between Mason type I (38% of the radial head surface) and type II (48% of the radial head surface). It was concluded that there is an important involvement of the anterior quadrants of the fracture. The mean size of the fracture is significantly larger in Mason type II compared to type I.

Posteriorly Displaced Radial Head Fractures May Represent the Footprint of an Elbow Dislocation or Subluxation as a Variant of Modified Mason Type 4.

The purpose of this case series is to describe surgical decision making and clinical outcomes in posteriorly displaced radial head fractures with a major fragment (more than 50% of the head) located behind the humeral condyle. We also document the outcome of open reduction and internal fixation of completely displaced radial head fractures. A retrospective review of the ICUC® (Integrated Comprehensive Unchanged Complete) database was performed between 2012 and 2020. Patients were included if preoperative radiographs demonstrated a major radial head fracture fragment located posterior to the humeral condyle and a minimum of 2-year follow-up data was available. Ten patients met inclusion criteria. Two patients had an associated elbow dislocation whereas 8 patients did not. All patients were found to have disruption of the lateral collateral ligament complex intraoperatively. Nine radial head fractures were successfully fixed with interfragmentary screws. One multi-fragmented radial head fracture could not be successfully stabilized with interfragmentary screw fixation and was resected. The average time to final follow-up was 4.8 years (range 2.2-8.1). At final follow-up, 6 patients demonstrated radiographic evidence of a healed radial head, 1 patient had avascular necrosis, and 2 had post-traumatic arthritis. None demonstrated radiographic instability. The average functional score was 0.64 (SD 0.81) and pain score was 0.45 (SD 0.93). The average elbow extension was 8 degrees (SD 11), elbow flexion was 139 degrees (SD 6), forearm supination was 60 degrees (SD 27), and forearm pronation was 69 degrees (SD 3). Recognition of a posteriorly displaced radial head fracture is essential, as it may be an indirect sign of elbow instability. This instability should be addressed during surgical intervention.

Relative Prevalence and Associated Factors of Complex Regional Pain Syndrome Type I in Patients with Radial Head Fractures Treated with Open Reduction and Internal Fixation: A Cross-Sectional Study.

Objective This cross-sectional study aimed to examine the incidence and associated factors of complex regional pain syndrome type I (CRPS I) in patients who underwent open reduction and internal fixation (ORIF) for radial head fractures. Methods The study enrolled 601 radial head fracture patients treated with ORIF, 523 of which completed the 1-year follow-up. The incidence of CRPS I in those patients was assessed using the Budapest criteria. Patients were then divided into 2 groups: patients with CRPS I (n = 28) and patients without CRPS I (n = 495). The patients' demographic and clinical data before the operation were prospectively collected by our team. Independent t-tests and χ2 tests were used as univariate analyses to compare the demographic and clinical data between the two groups. Meanwhile, multivariate regression analysis was conducted to identify the associated risk factors for CRPS I. Results The incidence of CRPS I in patients with radial head fractures treated with ORIF was 5.5% during the first year following surgery. Significant differences were observed in age, gender, type of trauma, modified Mason Classification, and depressive personality disorders. The logistic regression analysis revealed that the female gender, modified Mason type III fractures, and depressive patients were significantly more likely to develop CRPS I (p=0.021, 0.023, and 0.025, respectively). Conclusions The incidence of CRPS I among radial head fracture patients undergoing ORIF was 5.5%. In addition, early detection of CRPS I and providing adequate intervention will likely result in greater benefits for those patients.

Open Reduction Internal Fixation of Simple Versus Comminuted Radial Head Fractures: Comparison of Clinical Outcomes

Current teaching suggests that modified Mason type III and IV fractures of the radial head involving more than 3 fragments should be treated with radial head arthroplasty. The purpose of this study was to compare the outcome of simple (2 or fewer intra-articular pieces) versus comminuted (3 or more intra-articular pieces) radial head fractures treated with open reduction internal fixation (ORIF). This was a retrospective review of 35 patients with modified Mason type III and IV fractures treated with ORIF. For the purpose of our study, simple fractures were defined as having 2 or fewer intra-articular fragments. Comminuted fractures were defined as having 3 or more intra-articular fragments. The primary outcomes were Broberg and Morrey rating system and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Reoperation rates and complications were also noted. Thirty-five patients were evaluated, with a mean follow-up of 39.3 months. Thirteen patients had radial head fractures consisting of 2 or fewer intra-articular fragments. Twenty-two patients had radial head fractures consisting of 3 or more intra-articular fragments. Ages and follow-up times were similar in the 2 groups. Similar QuickDASH and Broberg and Morrey scores were seen when evaluating subgroups of 2, 3, and 4 fragment fractures. One patient from each group underwent revision surgery for symptomatic hardware. In our series, we found similar clinical outcome scores and reoperation rates between simple and comminuted radial head fractures treated with ORIF. Fractures with more than 3 intra-articular fragments can be considered for ORIF. Therapeutic IV.

Mason type III fractures of the radial head: ORIF, resection or prosthetic replacement?

PurposeThis study focused on a comparison of mid-term clinical, functional and radiographic outcomes of adults treated by open reduction and internal fixation (ORIF), radial head prosthesis (RHP) and resection (RHR).MethodsThe retrospective evaluation concerned 47 surgically treated patients after a mean follow-up of 53 months. All patients were grouped according to the surgical procedure performed: 15 in the RHP group, 16 in the ORIF group and 16 in the RHR group. At the follow-up, outcome assessment was based on radiographs, range of motion (ROM) and functional rating scores.ResultsPatients treated by RHR had significantly higher mean age and shorter operation time than other two groups. Compared to ROM, flexion, extension and pronation were significantly worse in patients treated by ORIF than those in the RHP group and the RHR group. Supination was significantly better in the RHP group. However, no statistical differences were observed in functional rating scores among the three groups. Regarding complications, instability was the only cause of revision surgery in the RHP group and the RHR group. On the other hand, the ORIF group revision rate was 50% and secondary displacement was the most frequent cause of failure.ConclusionThe ORIF group did not show good results with greater elbow stiffness and higher revision rate than the other two techniques. RHR may be suitable for elderly patients with lower functional demands as it reported good clinical results and reduced operation time.

Avoiding articular breakthrough in screw fixation of radial head fractures.

BackgroundThe radial head is anatomically complex, making fracture fixation challenging because of the difficult visualization of the articular surface. As a result, screw penetration into the radiocapitellar joint can often occur. To facilitate safe placement of screws tangential to the joint surface, we define an approximate and reliable distance from the articular rim of the radial head that can minimize the risk of articular breach.MethodsA Kirschner wire for cannulated drilling was placed tangential to the articular surface in 15 cadaveric proximal radii. The distance from the wire to the articular rim was measured 3 times. After insertion of a 3.5-mm compression screw, the radial head was divided in the coronal plane, bisecting the screw track, to visualize the cross section of the screw's position. Headless compression screws of 3.5 mm were placed the distance from the most proximal edge of the screw track to the radial head's articular surface was measured 3 times.ResultsThe average distance from the articular rim to the distal surface of the Kirschner wire was 5.1 mm. The average distance from the articular rim to the proximal edge of the cavity was 1.7 mm. The screw placement was subchondral and extra-articular in all cases.ConclusionWhen fixing Mason type 2 articular radial head fractures with 3.5-mm headless compression screws placed tangential to the articular surface, maintaining a screw entry point about 5 mm distal to the articular surface of the radial head will minimize the possibility of articular screw breach. This position also places the screw into subchondral bone, providing the best bone quality for mechanical support.

Radial head arthroplasty in mason type 3 and 4 radial head fractures: Functional efficacy and complications

Background: Radial head arthroplasty (RHA) is a best alternative to radial head excision in Mason III and IV fractures. The purpose of this study was to assess the outcomes of RHAs in terms of the range of movement and elbow stability using the Mayo elbow performance score (MEPS).Methods: A prospective and interventional study included 25 patients were performed RHAs. During follow up, patients were clinically and radiologically assessed and complications. Results: 92%of patients presented with excellent to good outcomes at 24 weeks (mean MEPS was 92.17±11).Conclusion: RHA is successfully performed in comminuted radial head fractures because of injury to lateral collateral complex and comminution.