Radial Neck Research Articles

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.

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.

Non-union of Conservatively Managed Radial Neck Fractures in Adults: A Systematic Review.

Non-union of radial neck fractures in adults is rare. This review aims to identify factors contributing to the non-union of undisplaced radial neck fractures and assess treatment options and outcomes. Systematic searches of English articles in PubMed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were undertaken in September 2021 according to the PRISMA guidelines. The search terms were (fracture) AND (radial neck) AND (non-union OR non-union). Eligible studies reported adults who experienced undisplaced radial neck fractures that went on to non-union without prior surgical intervention. Fifteen case reports/series were included involving 29 non-unions in 27 patients. The largest study included eight patients. There were 11 males (38%) and 18 females (62%). The average age at the time of the presentation was 55 (range: 29-73). In 13 cases, comorbidities were commented on, including association with smoking in 4 (30%), diabetes in 3 (23%), and excessive alcohol in 5 (38%). The average time from injury to a diagnosis of non-union was 6.7 (range: 2-24) months. The average time of follow-up was 28.6 (range:6-84) months. Eight minimally symptomatic or asymptomatic non-unions were managed conservatively without complication. Seventeen symptomatic non-unions were managed operatively. Treatments included open fixation (1), open fixation with bone grafting (1), bone grafting alone (2), arthroplasty (2), radial head resection (2), and unknown surgery (7). Patients managed operatively achieved full or near-full, asymptomatic range of motion at an average of 5.4 (3-12) months postoperatively. Non-union is a rare complication of an adult radial neck fracture, and risk factors may include female gender, smoking, diabetes, and chronic alcohol. Persistence with non-operative management is encouraged as it can resolve symptoms with or without a radiographic union. Operative options range from bone grafting +/- fixation to arthroplasty. On average, the time from injury to the decision made to operate is 6.5 (3-12) months. A comfortable, functional range of motion is possible with all treatment strategies.

Study of Short-Term Outcome of Surgically Managed Displaced Pediatric Radial Neck Fractures: A Case Series.

Pediatric radial neck fractures are relatively rare elbow injuries commonly seen in children between eight to 12 years of age. Judet type III and Judet type IV radial neck fractures require surgical intervention for optimal functional outcomes. The present study evaluates the functional results of Judet type III and IV radial neck fractures operated at a single center. This is a retrospective study conducted by using medical records of nine patients who had displaced radial neck fractures (Judet type III and type IV) treated at our institute which is a tertiary trauma care centerbetween January 2012 andDecember 2021. Patients were assessed for functional outcome by Mayo elbow performance score (MEPS), the Tibone and Stoltz functional criteria, and for complications with the average follow-up of four years(range: six months to seven years). Results: The mean age of the patients was 9.14 ± 2.2 years (range: four to 11 years). Seven (77.8%) patients were males and two (22.2%) patients were females. The right side was the most commonly injured side (right at 67%, left at 33%). Five (55%) cases were of Judet type III and four (45%) cases were of Judet type IV.Three cases treated with closed reduction and intramedullary nailing by the Metaizeau technique had excellent functional results. Among two patients treated with percutaneous pin leverage and intramedullary nailing by the Metaizeau technique, one patient had an excellent outcome, and the other had a good outcome. Among four casestreated with open reduction and K-wire fixation, two patients had good outcomes, one patient had a fairoutcome, and one patient had a poor outcome. The majority of moderately to severely displaced pediatric radial neck fractures which need intervention can be managed by the closed reduction technique of Metaizeau with or without pin leverage with excellent to good functional outcomes at short-term follow-up. Some cases need open reduction which also has good to fair outcomes. Initial trauma and associated injuries seem to play a role in the outcome rather than the treatment method per se. However, a larger sample size and longer follow-up are needed for comparisons and for arriving atbetter and definitive conclusions.

Type 4 congenital proximal radio-ulnar synostosis mimicking as malunited radial neck and deformed radial head with insidious onset extension block: a case report and results after excision

&lt;p class="abstract"&gt;Proximal radio ulnar synostosis is a rare entity presenting with restriction of supination and pronation. Among the various types, type 4 variety is even more-rare and its presentation, can pose a diagnostic challenge specially, if with history of trauma. Radiologically, it is usually overlooked as a malunited radial neck and therefore needs thorough evaluation. We presented a case of a 15-year-old male who complains of new onset extension block following trauma, with chronically restricted supination and pronation. History suggested the restriction in supination and pronation since birth, and the extension block occurring de novo. Radiographs and CT scan of the elbow revealed proximal radio-ulnar synostosis and anteriorly dislocated, mushroom-shaped radial head, misleading and mimicking like an old, neglected and malunited radial neck fracture with a deformed radial head. The family insisted to not address the restriction of supination pronation but, asked for solution to more disabling extension block. Thus, patient was managed with open procedure, involving radial head-neck excision and removal of malformed radial head. At 1-year follow-up, the child has a well-reduced and stable elbow joint with a functional range of flexion and extension movements with restricted supination and pronation. Type 4 congenital radio ulnar synostosis not only leads to conventionally known restriction of supination pronation but also give rise to extension block de novo as presented in this case. Excision of the deformed head and neck can treat the restriction in extension, however the synostosis will require various other augmented procedures.&lt;/p&gt;

Effect of Radiocapitellar Joint Over/Under Stuffing on Elbow Joint Contact Pressure

Comminuted radial head fractures are commonly treated by surgical resection or replacement with a prosthesis. A potential problem with radial head replacement is overlengthening of the radial neck ("overstuffing" of the radial head), which has been shown to affect both ulnohumeral kinematics and radiocapitellar pressures. We hypothesized that an overstuffed radial head prosthesis increases capitellar pressure and reduces coronoid pressure. Seven human cadaveric elbows were prepared on a custom-designed apparatus simulating stabilizing muscle loads, and passively flexed from 0° to 90° under gravity valgus torque while joint contact pressures were measured. Each elbow was tested sequentially with different neck lengths, starting with the intact specimen followed by insertion of understuffed (-2 mm), standard-height (0 mm), and overstuffed (+2 mm) radial head prostheses in neutral forearm rotation, 40° pronation, and 40° supination positions, respectively. Capitellar mean contact pressures significantly increased after insertion of an overstuffed radial head prosthesis. In valgus position with neutral forearm rotation, capitellar mean contact pressure on the joint with an intact radial head averaged 227 ± 70 kPa. Insertion of understuffed, standard-height, and overstuffed radial head prostheses changed the mean contact pressures to 152 ± 76 kPa, 212 ± 68 kPa, and 491 ± 168 kPa, respectively. The overstuffed radial head group had significantly lower whole coronoid mean contact pressures (153 ± 56 kPa) compared with the intact (390 ± 138 kPa) and standard-height (376 ± 191 kPa) radial head groups. An increase in radial prosthesis height significantly increases capitellar contact pressures and reduces coronoid contact pressures. Restoration of the anatomic radial head height is critical when performing radial head arthroplasty to maintain normal joint biomechanics. Elevated capitellar contact pressures can potentially lead to pain and early degenerative changes.

Anthropometric Study of Proximal Radius in Below-Average Height Thai Women and Its Correlation with Commercially Available Radial Head Prostheses.

Background: Most radial head prostheses were designed in Western countries based on the anatomical characteristics of Western populations. We hypothesised that these prostheses are too large for below-average height Thai women. The objective of this study is to evaluate the anthropometric parameters of the proximal radius in such a population and its correlation with commercially available prostheses. Methods: Dominant elbows of 124 Thai women whose height was <155 cm were studied. Using the standard anteroposterior and lateral radiographic images, the head diameter and thickness, the distance between the articular surface and radial tuberosity, the narrowest intra-medullary canal diameter and the narrowest outer diameter of the radial neck were measured. Correlations between body height and each radiographic parameter were assessed using the Pearson correlation coefficient (PCC). The specifications of the commercial metallic radial head implants were reviewed and used to evaluate the relevant radiographic parameters. Results: Mean of the minimum and maximum head diameter was 18.54 ± 1.11 mm and 19.13 ± 1.17 mm, respectively; the thickness was 7.43 ± 0.69 mm, the distance between the articular surface and tuberosity was 19.05 ± 1.45 mm, the intra-medullary canal diameter was 7.63 ± 1.2 mm and the outer diameter of the radial neck was 11.13 ± 1.26 mm. There is a poor correlation between the participant's height and each parameter (PCC ≤ 0.50). In 24.2% of the participants, the smallest size of prosthetic designs with a head diameter of 20 mm is larger than +2 mm in reference to minor diameter. The minimum prosthetic head thickness is greater than the average value of the participants in 12 out of 15 designs. One participant has an outer neck diameter smaller than the smallest stem diameter of three designs. Conclusions: Surgeons must be aware that commercially available radial head replacement implants may be too large for below-average height Thai women. Level of Evidence: Level IV (Prognostic).

Outcomes of Posterior Monteggia Variant Fractures Repaired Through a Trans-Olecranon Approach

To evaluate the clinical and radiographic outcomes and complications following surgical treatment of adult posterior Monteggia fracture variants in which coexisting radial head and coronoid fractures were addressed through a single extensile posterior trans-olecranon approach. We performed a retrospective review from January 1, 2010, to January 1, 2021, of all adult patients who underwent fixation of posterior Monteggia variant fractures with coexisting radial head and/or coronoid fractures through a trans-olecranon approach by a single surgeon. Patient records were reviewed for postoperative complications and radiographic outcomes. All patients were contacted to participate in a repeat clinical examination and functional assessment. Thirteen patients met the inclusion criteria, of which 7 agreed to participate. Final follow-up was conducted at an average of 49 months postoperatively. Six patients had a coexisting radial head fracture, 1 had a radial neck fracture, and all 7 patients had a coronoid fracture. All 7 coronoid fractures were repaired, 2 patients had internal fixation of the radial head, and 5 had radial head replacement. Four patients underwent reoperation. There were no cases of infection or heterotopic ossification, and all patients achieved radiographic bony union. The average final range of motion was 13°-133° flexion-extension (range: 0°-30° extension to 125°-145° flexion), 76° pronation (range: 70°-90°) and 72° supination (range: 60°-90°). The average Mayo Elbow Performance Score was 86 (range: 70-100), average Visual Analog Scale score was 1.4 (range: 0-3), and average Disabilities of the Arm, Shoulder, and Hand score was 9.8 (range: 0.83-35.83). Use of a single extensile trans-olecranon exposure offers reliable visualization and access to all bony structures requiring repair while minimizing soft tissue disruption. Patients treated with this trans-olecranon surgical approach demonstrate satisfactory clinical and radiographic outcomes with low rates of heterotopic ossification, nonunion, and infection. Therapeutic IV.

Satisfactory mid- to long-term clinical and radiographic outcomes after surgical treatment of radial neck fracture in 10 children.

ABSTRACTComplications after surgical treatment of pediatric radial neck fractures are common. The purpose of this study was to evaluate the mid- to long-term clinical and radiographic outcomes after surgical treatment of pediatric radial neck fractures. We assessed 10 children who had been surgically treated for radial neck fractures. We mainly performed percutaneous intrafocal pinning to reduce the fracture; where this was inappropriate, we performed open reduction. Mid- to long-term clinical and radiographic outcomes were assessed, as well as whether these affected patient-related outcomes (Hand 20 questionnaire) at the final follow-up. Of the 10 patients (seven boys; mean age, 9 years; age range, 5–14 years; four fractures on the right-hand side, six on the left), four each were grades II and III, and two were grade IV, according to the Judet classification. The mean follow-up time was 6.7 (range, 3.6–11.2) years. Eight patients had restricted forearm pronation. The mean radial neck angulation on the fractured side was 36° (range, 5°–96°), preoperatively, and 2° (range, 0°–11°) at the final follow-up. There were eight cases of radial head overgrowth, three of premature physeal closure, two of notching of the radial neck, and one of heterotopic ossification. According to the Leung/Peterson Classification, four patients had “excellent,” three had “good,” and three had “fair” functionality. Eight patients had a perfect score upon completing the Hand 20 questionnaire. In conclusion, postsurgical patient-related outcomes for the 10 cases were satisfactory despite slightly restricted forearm range of motion and complications detected using radiography.

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function.

Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic search was performed for studies that reported on fracture angulation, treatment details, and ROM on a minimum of five children with radial neck fractures that were followed for at least one year. Data on fracture classification, treatment, and ROM were analyzed. Results: In total, 52 studies (2420 children) were included. Sufficient patient data could be extracted from 26 publications (551 children), of which 352 children had at least one year of follow-up. ROM following the closed reduction (CR) of fractures with <30 degrees angulation was impaired in only one case. In fractures angulated over 60 degrees, K-wire fixation (Kw) resulted in a significantly better ROM than intramedullary fixation (CIMP; Kw 9.7% impaired vs. CIMP 32.6% impaired, p = 0.01). In more than 50% of cases that required open reduction (OR), a loss of motion occurred. Conclusions: CR is effective in fractures angulated up to 30 degrees. There may be an advantage of Kw compared to CIMP fixation in fractures angulated over 60 degrees. OR should only be attempted if CR and CRIF have failed.

A retrospective review of 101 operatively treated radial neck fractures in children and analysis of risk factors for functional outcomes

IntroductionRadial neck fracture is a less common injury in childhood and many factors are associated with the final functional outcomes. This study aimed to describe the clinical and radiological results of the patients with radial neck fractures treated surgically and assess the potential risk factors for poor functional outcomes. Patients and MethodsThis study enrolled 101 children with radial neck fracture and treated surgically at our department. Patients were followed up at least three years and assessed clinically and radiographically. The primary outcome of this study was the functional outcome assessed by using Metaizeau criteria and the secondary outcome was complications of radial head necrosis, postoperative radial nerve palsy, bone union, infection, and skin irritation. Related risk factors for unsatisfactory functional outcomes were recorded and analyzed by multivariable logistic regression. ResultsIn total, 101 patients with 101 elbows (44 on the left side, 57 on the right side) were evaluated in our study, including 55 females (54.5%) and 46 males (45.5%), with a mean age of 7.5±2.7 years old (range, 3 to 14 years). There were 65.3% excellent (66 cases), 18.8% good (19 cases), 11.9% fair (12 cases), and 4.0% bad (4 cases) results in these patients. The rate of satisfactory outcome was 65.3% (66/101) and the rate of “unsatisfactory outcome” was 34.7% (35/101). Complications included postoperative radial nerve palsies in 15 cases (14.9%), radial head necrosis in 4 cases (4.0%), skin irritation due to the nail-end in 5 cases (5.0%), infection in 2 cases (2.0%), and bone nonunion in 1 patient (1.0%). Only Judet type (OR, 5.78; CI, 1.72-19.39, p=0.005) and surgical method (OR, 12.68; CI, 2.55-63.06, p=0.002) were independent risk factors for the unsatisfactory functional outcomes. ConclusionsClosed reduction with intramedullary fixation is a primary treatment for type III and IV radial neck fractures in children. Fracture severity classified as Judet type IV and open surgical method were independent predictors for unsatisfactory functional outcomes.

Ultrasonography-Guided Combination with Elbow Arthrography-Assisted Minimally Invasive Treatment of Radial Neck Fractures in Young Children.

Background A radius neck fracture in children is a common fracture that not only affects the growth and development of children but also has a certain impact on the function of children's elbow joints. Objective To probe into the application value of ultrasonography- (US-) guided combination with elbow arthrography in the minimally invasive treatment of radial neck fractures in young children, summarize its clinical effect and provide a minimally invasive, safe, effective, and reliable method for treating radial neck fractures in young children. Methods Seventy-three patients with type III or IV radial neck fractures were treated from June 2013 to December 2020 and were divided into the Métaizeau group (n = 31, treatment group) and Kirschner wire (k-wire) k-wire group (n = 42, control group). The Métaizeau group was given US-guided combination with elbow arthrography-assisted modified Métaizeau technique, the k-wire group received open reduction and internal fixation with k-wire and compared the surgical effect of the two groups. Results In comparison with the k-wire group, time of operation, intraoperative bleeding volume, and hospital stay were signally junior to those in the Métaizeau group (P < 0.05). After surgery, in comparison with the k-wire group, the number of degrees to contralateral flexion or forearm rotation was visually lower in the Métaizeau group (P < 0.05), and postoperative complication incidence in the Métaizeau group was visually lower than that in k-wire group (P < 0.05). Conclusion In the minimally invasive treatment of radial neck fractures, US-guided combination with elbow arthrography in young children has better efficacy and high safety. It can be widely promoted and applied clinically.

Metaizeau Technique for Displaced Radial Neck Fracture among Children in Erbil, Kurdistan Regional Government, Iraq

Background and objectives: Radial neck fracture if not propely managed can lead to complications including pain and avascular necrosis. The Metaizeau technique of closed intramedullary pinning is a treatment option and it is the aim of this study to assess its outcome. Methods: Metaizeau technique was used in managing radial neck fracture of 21 children at two emergency hospitals in Erbil, Kurdistan region, Iraq. between July 2018 and September 2019. Postoperative outcome were assessed according to the Metaizeau classification and Mayo performance score to assess degree of residual angulation as well as for postoperative complications such as joint stiffness. Results: Median follow up time was 10 months (7-12 months). The children’s median age was nine years (6-11 years), among which 11 (52%) cases were females. According to Judet classification, 9 (43%) children had class IVb fracture while 8 (38%) had class IVa and only 4 (19%) cases had class III fracture. The median fracture angulation prior to the surgery was 75° (ranged between 50-85°). By the end of the follow up, 19 (90.5%) cases achieved excellent results according to the Metaizeau classification while the remaining two (9.5%) had good outcome with mild degree of angulation of 8° and 14° respectively. Conclusions: Metaizeau method is technically easy with a simple learning curve and is highly effective with excellent functional outcomes and that the rate of postoperative complications is rare compared to reported cases of radial neck fracture managed with open reduction and internal fixation

A prospective study to find the functional outcome of displaced radial neck fracture among children treated with closed reduction internal fixation with intramedullary nailing

Background: Radial neck fracture among children is very common. If fractures not treated early it further leads to malunion. Number of times such malunion are irreversible and may lead to disability for lifetime. The most important set of problems that can happen in this fracture involves the blood supply to the radial head. The radial head is supplied by periosteal vessels in the neck. As a result, any trauma to the proximal end of the radius (with or without a fracture) will produce an aseptic necrosis of the radial neck and head of varying severity. This can precipitate a slight shortening of the proximal end of the radius with a propensity toward slight valgus deviation of the elbow axis. However, the concurrent widening and thickening of the radial head and neck are more significant; in extreme cases, this can restrict pronation and supination. One of the recent advances in treatment of distal radius fractures is the more frequent application of open reduction and internal fixation, especially for intra-articular fractures and other one is treated with treated with closed reduction internal fixation with intramedullary nailing.

The radial artery running over the anatomical snuffbox: a case report

The radial artery, a terminal branch of the brachial artery, typically originates at the level of the radial neck. It runs under the cover of the brachioradialis muscle, descending along the lateral side of the forearm with paired accompanying veins and a superficial branch of the radial nerve. The radial artery rewinds around the lateral aspect of the wrist, passing beneath the tendons of the abductor pollicis, extensor pollicis longus, and extensor pollicis brevis. Finally, it crossed the floor of the anatomical snuffbox. This case report presents an anatomical variant in which the radial artery runs over the radial fossa, that is, superficially of the tendons of the hand's abductor pollicis, extensor pollicis longus, and extensor pollicis brevis muscles. The variation described in this paper sheds light on the possible atypical topographical relationships of the radial artery with the neighboring anatomical structures in the wrist, which can be crucial during hand surgery procedures.

Métaizeau Closed Reduction Technique and Open Reduction Technique for the Surgical Treatment of Pediatric Radial Neck Fractures.

To compare the functional outcomes of pediatric radial neck fractures treated with percutaneous reduction using Kirschner (K) wire with the Métaizeau technique, and that with open reduction plus internal fixation with K-wire. Comparative descriptive study. Haseki Training and Research Hospital Orthopedics and Traumatology Department, from December 2007 to December 2018. Children aged under 15 years, with radial neck fractures were inducted. The injury was classified according to Judet classification and the type IV was treated with either of the above technique. The inclusion criteria were a diagnosis of Judet type IV radial neck fracture and a minimum follow-up of 12 months. Exclusion criteria were patients with concomitant elbow fracture, follow-up for <12 months, failure to complete the Mayo Elbow Performance Score (MEPS) functional assessment, patients with missing data. Radiological results were evaluated in accordance with the Ursei Classification. MEPS was used to assess functional development. Forty-seven children (25 boys and 22 girls) aged (5-14 years with mean age of 8.57 ± 2.3 years were inducted. The surgical approach was the Métaizeau technique in 22 patients and open reduction technique in 25 patients. MEPS in the Métaizeau technique group was 95.2, with excellent results in 15 patients (68%), good results in 7 (31%), and fair or poor results in none of the patients. The mean MEPS in the open reduction / K-wire group was 88, with excellent, good, fair, and poor results in 9 (36%), 12 (48%), 4 (16%), and none of the patients, respectively. Closed reduction using the Métaizeau technique with the elastic stable intramedullary nailing method satisfies all the criteria for minimally invasive bone surgery. This approach was forward to be considerably efficient, with excellent functional and esthetic outcomes and a low rate of complications if the indications and biomechanical principles are considered. Radial neck, Métaizeau technique, Judet classification.

Radial neck osteolysis after radial head replacement: Functional impact and risk factors

IntroductionOnset of radial neck osteolysis (RNO) has been reported after radial head replacement (RHR), but data are sparse regarding impact and risk factors. We therefore conducted a retrospective study, 1) to quantify RNO after RHR, 2) to assess clinical and radiological impact, and 3) to identify risk factors. HypothesisRNO prevalence is high, but functional impact is limited. Material and methodA single-center retrospective study included all patients undergoing RHR for acute radial head fracture between 2008 and 2017: 53 patients, with a mean age of 53.8±15.7 years [range, 21–85 years]. At a minimum 2 years’ follow-up, patients were assessed clinically on joint range of motion and Mayo Elbow Performance Score (MEPS) and radiologically on standard radiographs. Associations between RNO and various parameters were assessed. ResultsAt a mean 46.7±19.8 months’ follow-up [range, 24–84 months], RNO was found in 54.7% of cases (29/53), with mean 4.0 ±2.8mm distal extension [range, 1.2–13.4mm], corresponding to 13.4±7.3% of stem height [range, 2.7–27.7%].RNO at last follow-up was not significantly associated with reduced flexion-extension (121.9° versus 114.0°; p=0.11), pronation-supination (152.6° versus 138.3°; p=0.25) or MEPS (84.7 versus 84.8; p=0.97), or with higher rates of postoperative complications (11/29 (37.9%) versus 7/24 (29.2%); p=0.782) or surgical revision (11/29 (37.9%) versus 10/24 (41.7%); p=0.503).RNO was significantly associated with cementless fixation (19/29 (65.5%) versus 7/24 (29.2%); p=0.01), unipolar prosthesis (21/29 (72.4%) versus 7/24 (29.2%); p=0.002), high filling-ratio, whether proximal (88% versus 77%; p=0.002), middle (84% versus 75%; p=0.007) or distal (69% versus 59%; p=0.032), and shorter radial stem (33.2mm versus 46.3mm; p=0.011). No demographic parameters showed significant association with RNO at last follow-up. ConclusionRNO was frequent after RHR, but without clinical or radiological impact in the present series. The risk factors identified here argue for involvement of stress shielding. Level of evidenceIV, cohort study.

Anatomic Radial Head Arthroplasty: The Importance of Implant Angle

Multifragmentary radial head and neck fractures not amenable to open reduction and internal fixation are usually treated with radial head arthroplasty (RHA). Although the optimal implant design is still subject to debate, anatomic designs are common. We hypothesized that positioning of the implant leading to increased radial stem angle (RSA) (angle of the RHA stem with respect to the proximal radius shaft, RSA) in anatomic RHA designs will contribute to failures. The aim of this study was to characterize the risk of RHA failure with respect to the stem angle in anatomic RHA design. A retrospective review of patients who underwent anatomic RHA for acute fractures between 2006 and 2019 at 2 academic centers was conducted. Initial postoperative elbow radiographs were reviewed to measure RSA on the anterior-posterior and lateral views. Radiolucency, stress shielding, and radiocapitellar arthritis were also evaluated. Implant failure was defined as prosthesis removal or revision. Implant failure was associated with significantly larger lateral RSA than that in intact implants. Increasing stem shaft angle on a lateral radiograph was associated with decreased implant survival. Radiolucency, stress shielding, and radiocapitellar arthritis were similar between the 2 groups. Anatomic radial head implants are commonly used; however, the importance of prosthesis positioning, specifically that of the stem within the proximal radius, remains understudied. Higher RSA is associated with the risk of implant failure and need for revision. Prognostic IV.

Open Reduction of Displaced Radial Neck Fractures in Children by Internal Fixation Techniques: Comparison of Percutaneous Kirschner Wiring and Elastic Stable Intramedullary Nailing.

Although most paediatric radial neck fractures can be treated with closed reduction, some severely displaced fractures require open reduction. The purpose of this study is to compare the effects of ESIN and KW fixation in open reduction of radial neck fracture in children. Twenty-four patients with mean age of 8.5years were included. Four of the patients had a Judet type III fracture and 20 had a Judet type IV fracture. Ten patients who underwent percutaneous KW fixation were assigned to group A, while 14 patients who underwent ESIN fixation were assigned to group B. Variables of interest included age, sex, fracture type, associated lesions, surgical time, fracture reduction, cost, follow-up, healing time, X-rays, clinical outcomes, and complications. There were no significant between-group differences in sex, age, additional injuries, fracture type, and quality of reduction. Costs were significantly lower in Group A. Fracture healing was achieved in 23 of 24 patients (10/10 in group A and 13/14 in group B). In a postoperative elbow function assessment based on the Steele and Graham classification, 80% of patients in group A had a score of excellent or good, compared to 78.6% of patients in group B. Two cases of nail shifting and joint protrusion were observed in group B, one of which also presented with nonunion during follow-up. Both KW and ESIN may achieve good clinical outcomes, but KW is associated with lower costs, easier implant removal (without the need for a secondary surgery), and lower iatrogenic complications.

The Effects of Using K-Wire or Titanium Elastic Nails on Clinical and Radiological Outcomes in the Métaizeau Closed Reduction Technique

Aim The purpose of this study was to compare the effects of using Kirschner-wire (K-wire) or titanium elastic nails (TEN) on the functional results of patients treated with the Métaizeau closed reduction technique, which is a popular treatment modality for pediatric radial neck fractures (PRNF). Methods Patients who underwent the Métaizeau closed reduction technique for PRNF between May 2017 and May 2019 were assessed retrospectively. The Judet classification was used for the PRNF classification. The study consisted of patients who underwent the Métaizeau technique for Judet Type IV PRNFs and had at least 12 months of follow-up. Results This study enrolled a total of 43 patients, 22 females and 21 males. Their mean age was 8.69 ± 2.3 at the time of surgery. The mean MEPS of patients undergoing K-wire surgery was 89.50, while the mean MEPS of patients undergoing TEN surgery was 92.83. There was no statistically significant difference between the two groups in terms of MEPS. When the complication rates of the two groups were evaluated, there was no statistically significant difference between them. The cost per patient for TEN was $40. The cost per patient for the K-wire was $1. Conclusion The effect of K-wire or TEN used in the Métaizeau closed reduction technique on clinical outcomes is similar, and K-wire is more cost-effective.