Radial Head Fractures Research Articles

Recognition of the pattern of complex fractures of the elbow using 3D-printed models.

This study aimed to answer the following questions: do 3D-printed models lead to a more accurate recognition of the pattern of complex fractures of the elbow?; do 3D-printed models lead to a more reliable recognition of the pattern of these injuries?; and do junior surgeons benefit more from 3D-printed models than senior surgeons? A total of 15 orthopaedic trauma surgeons (seven juniors, eight seniors) evaluated 20 complex elbow fractures for their overall pattern (i.e. varus posterior medial rotational injury, terrible triad injury, radial head fracture with posterolateral dislocation, anterior (trans-)olecranon fracture-dislocation, posterior (trans-)olecranon fracture-dislocation) and their specific characteristics. First, fractures were assessed based on radiographs and 2D and 3D CT scans; and in a subsequent round, one month later, with additional 3D-printed models. Diagnostic accuracy (acc) and inter-surgeon reliability (κ) were determined for each assessment. Accuracy significantly improved with 3D-printed models for the whole group on pattern recognition (acc2D/3D = 0.62 vs acc3Dprint= 0.69; Δacc = 0.07 (95% confidence interval (CI) 0.00 to 0.14); p = 0.025). A significant improvement was also seen in reliability for pattern recognition with the additional 3D-printed models (κ2D/3D = 0.41 (moderate) vs κ3Dprint = 0.59 (moderate); Δκ = 0.18 (95% CI 0.14 to 0.22); p ≤ 0.001). Accuracy was comparable between junior and senior surgeons with the 3D-printed model (accjunior = 0.70 vs accsenior = 0.68; Δacc = -0.02 (95% CI -0.17 to 0.13); p = 0.904). Reliability was also comparable between junior and senior surgeons without the 3D-printed model (κjunior = 0.39 (fair) vs κsenior = 0.43 (moderate); Δκ = 0.03 (95% CI -0.03 to 0.10); p = 0.318). However, junior surgeons showed greater improvement regarding reliability than seniors with 3D-printed models (κjunior = 0.65 (substantial) vs κsenior = 0.54 (moderate); Δκ = 0.11 (95% CI 0.04 to 0.18); p = 0.002). The use of 3D-printed models significantly improved the accuracy and reliability of recognizing the pattern of complex fractures of the elbow. However, the current long printing time and non-reusable materials could limit the usefulness of 3D-printed models in clinical practice. They could be suitable as a reusable tool for teaching residents.Cite this article: Bone Joint J2023;105-B(1):56-63.

Evaluation of functional outcome of prosthetic replacement of comminuted radial head and neck fractures in young adults

Evaluation of functional outcome of prosthetic replacement of comminuted radial head and neck fractures in young adults

A clinico-radiological study of radial head replacement vs excision in comminuted radial head fractures

A clinico-radiological study of radial head replacement vs excision in comminuted radial head fractures

A case report of post traumatic radioulnar synostosis after isolated closed radial head fracture with radial head subluxation

A case report of post traumatic radioulnar synostosis after isolated closed radial head fracture with radial head subluxation

Functional outcomes of patients with comminuted radial head fracture undergoing radial head arthroplasty

Functional outcomes of patients with comminuted radial head fracture undergoing radial head arthroplasty

Bilateral Radial Head Fracture with Unilateral Terrible Triad Injury in a Military

Bilateral Radial Head Fracture with Unilateral Terrible Triad Injury in a Military

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.

Fractures of the Proximal Ulna: A Spectrum of Injuries and Outcomes.

The purpose of this study is to assess the effect of radial head/ neck injury in association with proximal ulna fractures. Between 2006 and 2020, 107 patients presented to our academic medical center for treatment of a proximal ulna fracture and were enrolled into an IRB-approved database. Radiographs, injury details, and surgical interventions were retrospectively reviewed. Patients were classified as having an isolated proximal ulna fracture (PU), a PU fracture with an associated radial head dislocation (M-D), or a Monteggia fracture with an associated radial head fracture (M-V). Clinical and functional outcomes were assessed at follow-up to determine what differences exist between fracture patterns. Statistics were generated using Chi-squared tests for categorical variables and one-way ANOVA tests for numerical variables. While all patients ultimately healed, time to radiographic healing in the PU cohort was shorter at 3.57 ± 1.7months when compared to the M-V cohort (5.67 ± 3.8months) (p < 0.05). At follow-up, patients in the M-V cohort had poorer elbow pronation and supination when compared to the PU and M-D cohorts (p < 0.05). Patients within the PU cohort had fewer complications than those in the M-D and M-V cohorts (p < 0.05). No differences were found between the three cohorts in regard to rates of reoperation, non-union, wound infection, and nerve compression (p > 0.05). The Monteggia fracture with a concomitant radial head/neck fracture is a more disabling injury pattern when compared to an isolated proximal ulna fracture and Monteggia fracture without an associated radial head/neck fracture.

Recovery Trajectories Following Complex Elbow Injuries and Radial Head Arthroplasty: A Longitudinal Study Over 8 Years

Radial head arthroplasty (RHA) is commonly performed to manage comminuted unreconstructible radial head fractures. Although the outcomes of RHA are often satisfactory, revisions are usually considered when pain intensity is higher than expected. Therefore, it is important to investigate the recovery trajectories of patients following RHA over an extended period and the characteristics that may lead to unfavorable outcomes. The Patient-Rated Elbow Evaluation (PREE) was used to assess recovery in 94 patients at baseline (within 2-7 days after surgery); 3 and 6 months; and 1, 2, 3, 4, 5, and 8 years after RHA. Lower PREE values indicate lower pain and disability. Latent growth curve analysis was used to determine classes of recovery. The characteristics of the participants in the identified recovery trajectory classes were then compared. Two distinct recovery trajectories were identified: optimal and suboptimal recoveries. Most patients (84%) belonged to the optimal recovery class, which exhibited significantly lower baseline PREE scores, a consistent pattern of recovery, and a relatively high rate of change. Patients in the suboptimal recovery class (16%) had significantly higher baseline PREE scores and continued to experience relatively higher levels of pain and disability for the duration of the study; their rate of recovery was much slower. Patients belonging to the 2 recovery trajectories did not differ based on age or sex. Although we had low power in other variables, a qualitative exploration showed that the number of current or previous smokers was higher in the suboptimal recovery trajectory class. In this longitudinal cohort study, we show that high postsurgical pain and disability, and potentially smoking, may adversely affect the recovery trajectory following RHA. Clinicians are recommended to assess these potential factors while considering revision surgeries. Prognostic IV.

Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation.

We surgically treated comminuted radial head and neck fractures using headless compression screws, including multiple screws for the radial head and a single oblique screw for the radial neck. This study aimed to compare the clinical and radiological results for comminuted radial head and neck fractures between surgery using headless compression screws with a single oblique screw for the radial neck, our new procedure, and a plate system precontoured to the proximal radius. This retrospective study included 23 patients (11 and 12 in the screw and plate groups, respectively). The fractures were type 3 according to the Mason-Johnston classification modified by Broberg and Morrey. Clinical outcomes analyzed included the motion range of the elbow and forearm, Mayo Elbow Performance Score, and radiological assessments. In addition, postoperative complications were also investigated. The average follow-up was 18months. The bone union was achieved in all the patients, and there were no significant differences in clinical outcomes and radiological assessments except forearm supination (p = 0.02). Furthermore, additional surgical procedures were performed in one and five patients in the screw and plate groups, respectively (p = 0.16). Posterior nerve palsy was observed in two patients in the plate group. Complications were observed in one and six patients in the screw and plate groups, respectively (p = 0.07). Both surgical procedures achieved good clinical and radiological outcomes with bone and ligament injury repair. The screw group had a greater range of forearm supination than the plate group.

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.

Acute versus delayed radial head arthroplasty for the treatment of radial head fractures.

Radial head arthroplasty (RHA) is an important tool in the acute treatment of comminuted radial head and neck fractures. RHA is also performed in a delayed manner after failed open reduction and internal fixation, for fracture malunion or nonunion, and other chronic post-traumatic elbow disorders where restoration of the lateral column of the elbow is considered necessary. The relative efficacy and longevity of acute vs. delayed RHA is unknown. We sought to compare clinical, radiographic, and patient-reported outcomes between these groups. We identified patients ≥18 years old who underwent an RHA between 2000 and 2018 and then extracted 135 total elbows with a mean follow-up of 2.3 years that sustained isolated radial head fractures (30%), terrible triad injuries (66%), or Essex-Lopresti injuries (4%). The acute cohort (RHA: <12 weeks) contained 101 elbows that underwent surgery at a mean of 0.6 weeks (range, 0 days to 7 weeks, 96%<2 weeks) from injury, whereas the delayed cohort (RHA: 12 weeks to 2 years) contained 34 elbows that underwent surgery at a mean of 36 weeks (range, 14-82 weeks) from injury. Patients in the acute group had a higher percentage of terrible triad injuries (75% vs. 40%, P<.001) and Mason 3 fractures (98% vs. 45%, P<.001). At the final follow-up, 13 of 101 patients in the acute cohort (13%) and 7 of 34 patients in the delayed cohort (21%) required implant revision or resection. A total of 25 patients (25%) in the acute cohort and 12 patients (35%) in the delayed cohort required a reoperation. Kaplan-Meier 2-year survival estimates free of implant resection or revision (90% acute, 86% delayed) and reoperation (76% acute, 70% delayed) were similar between groups. In patients with 5-year follow-up, there was an increased rate of revision or resection in the delayed group (30% vs. 13%). Two-year survival estimates free of radiographic loosening were 80% in the acute cohort vs. 57% in the delayed cohort (P=.04). Mayo Elbow Performance Score at 2 years demonstrated mean scores of 83 and 79 in the acute and delayed groups, respectively, with 71% of the acute cohort and 64% of the delayed cohort achieving good or excellent scores. Our results demonstrated that although 2-year Kaplan-Meier survival free of revision or resection estimates and reoperation rates was equivalent between the groups, the delayed group experienced worse Mayo Elbow Performance Score outcomes, a higher revision or resection rate at 5 years, and an increased rate of radiographic loosening.

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.

Radial head distalisation with an external ring fixator as a therapy option in children with chronic posttraumatic radiocapitellar dislocations.

Missed monteggia-type injuries in children can result in chronic radial head dislocation with anatomic changes and osteoarticular remodeling of the radial head. In later stages, joint reconstruction is impossible and a functional radial head distalization can be a therapy option in symptomatic patients. From 2010 to 2018, 46 patients (18 female and 28 male, mean age 11.8 (4-20)) with chronic radius head dislocation treated in our institution were retrospectively analyzed. A radial head distalization was performed in symptomatic patients at the time of ulna lengthening and angulation by use of an external ring fixator. We analyzed the surgical and radiographic data as well as the clinical outcome of the patients measured by DASH and Mayo Elbow score. 16 patients (6 female, 10 male) fulfilled the criteria for functional radial head distalization. Main reason was Monteggia injury in 11 cases, and radial head fracture in 5 cases. Average follow-up was 5.1years (range 1-9, SD 2.1). Mean time from injury was 4.14years (range: 4months to 12years, SD 3.5years). Mean duration of external fixation was 106days (range 56-182, SD 31.2), lengthening was 21.3mm (range 12-42, SD 8.8). Average degree of sagittal angulation 14.8° (0-32°, SD 10.7°), coronal angulation 4.4° (0-25°, SD 7.3°). DASH score showed a good result with 2.4, and the MAYO Elbow Score was excellent (95/100). No secondary luxation of the radius head was detected. Radial head distalization with external ring fixator can be a therapy option for chronic radius head dislocations in symptomatic patients without losing stability of the elbow joint in contrast to radial head resection.

Clinical and radiological outcome of Mason-Johnston types III and IV radial head fractures treated by an on-table reconstruction

BackgroundOnly few methods treating comminuted radial head fractures have been established providing sufficient joint reconstruction, restoring radial length and enabling early joint mobilization. When an anatomical reconstruction using open reduction and internal fixation is not possible, radial head resection or primary arthroplasty is often conducted. An “Ex situ/on-table” reconstruction is widely disregarded but can be an option. The purpose of this study was to evaluate the functional and radiological outcome of comminuted radial head fractures treated with an “on-table” reconstruction and internal fixation using a low profile plate.MethodsFourteen patients who sustained a radial head fracture (9 Mason-Johnston type III and 5 Mason-Johnston type IV) and were treated with an “on-table” reconstruction between 2010 and 2020 were evaluated retrospectively. The patients mean age was 41.3 years (range 21–69). The clinical evaluation included active range of motion, grip strength, pain level and elbow stability. The functional outcome was assessed using the Disability of Arm, Shoulder and the Hand (DASH) score, Mayo Elbow Performance Index (MEPI), Broberg and Morrey score. The radiological examination included a.p. and lateral views of the injured elbow to evaluate nonunions, loss of reduction, joint alignment, avascular radial head necrosis, heterotopic ossifications and posttraumatic osteoarthritis.ResultsThe inclusion rate was 74% with a mean follow-up of 50 months (range 16–128). The mean elbow flexion of the injured side was 126° (range110–145°) with an average extension loss of 8° (range 0–40°). Pronation was 65° (15–90°) and supination 66° (5–90°). The mean MEPI was 87 points (range 45–100). The mean DASH score was 13 points (range 1–88). According to the Broberg and Morrey functional scoring system, the average score was 92 points (range 88–100). Complete bone union was achieved in 9 cases, partial union in 4 cases and nonunion in one case. There were no signs of avascular necrosis of the radial head. Signs of post-traumatic osteoarthritis were seen in 11 cases. Five patients needed an implant removal due to a radio-ulnar impingement and one patient a revision surgery due to the nonunion and implant breakage.ConclusionsAn on-table (ex situ) reconstruction of the radial head is a reliable option with a good clinical outcome and low complication rate in the surgical treatment of comminuted radial head fractures. It can restore joint alignment and maintain radial length. The risk for avascular necrosis is neglectable, and the bone healing rate is high.

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.

A comparative study of outcome of radial head fracture treated with radial head replacement and radial head excision alone

: Radial head fractures are the most common fractures of the elbow with an estimated incidence of 2.5 to 2.9/10,000 people/ year. The incidence of radial head fractures is reported to be between 1.7 to 5.4 percent of all fractures. : This study aims to assess the clinical outcome of excision arthroplasty and prosthesis replacement in treatment of comminuted radial head fractures. : Patients with radial head fracture presenting to orthopaedics department and emergency room were included for the study. Excision arthroplasty was performed in 25 patients and replacement arthroplasty was performed in 25 patients. The functional outcome of both the procedure were compared using DASH, MEPS and Broberg and morrey scoring system. : Based on the DASH score Replacement group showed good improvement at the end of the 6 month follow-up with the mean score of 15.9 (P=0.042). Based on the MEPS score the mean MEPS score showed replacement group had a good improvement at the end of 6 month follow-up with the mean score of 15.9 (P=0.042). : From this study we concluded, radial head replacement is a reasonable option for unreconstructable radial head fractures. Radial head replacement can achieve effective radiocapitellar contact that will improve the stability in valgus, posterolateral, and axial loading of the forearm. This treatment option has satisfactory short- and mid-term results even with other combined elbow injuries.

Study of characteristics and treatment of "kissing fracture" of humeroradial joint

To explore the clinical characteristics and treatment of "kissing fracture" of humeroradial joint. A clinical data of 12 patients with "kissing fracture" of the humeroradial joint between January 2016 and June 2021 was retrospectively analyzed. There were 8 males and 4 females with an average age of 41.9 years (range, 15-75 years). The fractures caused by falling in 7 cases, by falling from height in 3 cases, and by sports in 2 cases. The time from injury to admission was 2-72 hours (median, 2 hours). According to Mason's classification, the radial head fractures were rated as type Ⅰ in 2 cases, type Ⅱ in 8 cases, and type Ⅲ in 2 cases. According to Grantham's classification, the humeral capitulum fractures were rated as type Ⅰ in 10 cases and type Ⅱ in 2 cases. Among them, 4 cases of Grantham type Ⅰ humeral capitulum fracture were missed by X-ray film and confirmed by CT and/or MRI. Four cases were complicated with other injuries of elbow joint. The radial head fractures were fixed with screws or mini plate in 11 cases and treated conservatively in 1 case; the humeral capitulum fractures were fixed with screw or plate in 9 cases, removed in 1 case, and treated conservatively in 2 cases. X-ray film was used to evaluate the fracture healing; Mayo Elbow Performance Score (MEPS) was used to evaluate the functional recovery of the affected limb, and the range of motion (ROM) of the elbow joint of the affected limb was detected. All the incisions healed by first intention without early complications. All patients were followed up 10-24 months, with an average of 15.2 months. X-ray films showed that all fractures healed, and the healing time was 2-3 months, with an average of 2.3 months. At last follow-up, the ROM of flexion-extension of the elbow joint was 65°-161°, with an average of 136.9°; the ROM of rotation was 70°-180°, with an average of 149.2°. MEPS ranged from 70 to 100, with an average of 87.4; 8 cases were excellent, 2 cases were good, and 2 cases were fair; the excellent and good rate was 83.3%. The "kissing fracture" of the humeroradial joint is relatively rare, and the humeral capitulum fracture is milder than radial head fracture. X-ray examination alone can easily miss the diagnosis of Grantham type Ⅰ humeral capitulum fracture. The "kissing fracture" of the humeroradial joint is treated according to the principle of intra-articular fracture, and the good effectiveness can obtain.

A systematic review and meta-analysis on different stem fixation methods of radial head prostheses during long-term follow-up

Background: Radial head arthroplasty (RHA) is typically performed for non-reconstructible radial head fractures with or without valgus stability. The fixation methods can be divided into cemented rigid fixation, such as screw fixation, and uncemented micromovement fixation, including smooth stem, press-fit, expanded device, in-growth stem, and grit-blasted stem fixations. Different fixation methods may impact long-term clinical outcomes and cause complications. This study aimed to compare the long-term follow-up outcomes of cemented and uncemented radial head prostheses. Methods: A computerized literature search was performed in the PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases for studies on radial head prostheses, replacement, and arthroplasty published from inception to April 2022. The prostheses fixation method was divided into cemented and uncemented fixation groups. The outcomes of interest included the participant characteristics, prostheses types, clinical outcomes, reoperation rates, and complication rates during long-term follow-up. Results: A total of 57 studies involving 2050 patients who underwent RHA were included in our analysis. Cemented fixation was used in 23 of these studies, uncemented fixation in 35 studies, and both cemented and uncemented fixations in one study. Both fixation groups showed significantly improved clinical outcomes after treatment. In particular, both the reoperation and complication rates were lower in the uncemented fixation group (12% and 22%, respectively) than that in the cemented fixation group (20% and 29%, respectively). Among the studies, uncemented monopolar fixation had the lowest reoperation rate (14%), while cemented monopolar fixation had the highest reoperation rate (36%). Regarding complication rates, uncemented bipolar fixation yielded the lowest rate (12%), while cemented bipolar fixation yielded the highest rate (34%). The range of motion and clinical outcome scores were good in both groups. Conclusion: Uncemented radial head prostheses had lower reoperation and complication rates than cemented prostheses. In particular, uncemented monopolar prostheses may yield the lowest reoperation rate, while uncemented bipolar prostheses may yield the lowest overall complication rate.