Comminuted fractures of the radial head. Comparison of resection and internal fixation
ABSTRACT Satisfactory internal fixation of comminuted radial head fractures is often difficult to achieve, and radial head resection has been the accepted treatment. In this study, we compared the results of radial head resection with those of open reduction and internal fixation in patients with a comminuted radial head fracture.
Twenty-eight patients with a Mason type-III radial head fracture (some with associated injuries) were enrolled in the study. Fifteen patients underwent radial head resection as the initial treatment (Group I), and thirteen patients underwent open reduction and internal fixation (Group II). The age at the operation averaged 41.1 and 38.2 years, respectively, and the duration of follow-up averaged ten and three years, respectively. The outcomes were assessed on the basis of pain, motion, radiographic findings, and strength measured with Cybex testing. The overall outcome was rated with the functional rating score described by Broberg and Morrey and with the American Shoulder and Elbow Surgeons Elbow Assessment Form.
Elbow motion averaged 15.5 degrees (extension loss) to 131.4 degrees (flexion) in Group I and 7.1 degrees to 133.8 degrees in Group II. The carrying angle and ulnar variance averaged 8.2 degrees and 1.9 mm in Group I and 1.5 degrees and 0.5 mm in Group II. Compared with Group II, Group I had a loss of strength in extension, pronation, and supination (p < 0.01). The Broberg and Morrey functional rating score averaged 81.4 points in Group I and 90.7 points in Group II (p = 0.0034). The score on the American Shoulder and Elbow Surgeons Elbow Assessment Form averaged 87.3 points in Group I and 94.6 points in Group II (p = 0.0031).
The patients in whom the comminuted radial head fracture was treated with open reduction and internal fixation had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection. These results support a recommendation for open reduction and internal fixation in the treatment of this fracture.
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- "In a small prospective study, Ikeda et al.11 compared ORIF to resection of the radial head for treatment of Mason type III fractures in 28 patients. Fifteen patients underwent radial head resection and 13 underwent ORIF. "
ABSTRACT: The evidence for optimal management of Mason type III fracture of radial head is unclear hence a systematic review of the published literature was performed in April 2012. This review includes 5 prospective studies (including 2 randomized trials), 4 retrospective studies and 9 case series. No study can be interpreted as level 1 evidence. Level 2 and 3 evidence provides some insight into the success of each modality through subjective and objective measurements of function and complication rates. Radial head replacement, open reduction internal fixation (ORIF) and radial head resection all provide satisfactory outcomes for patients in most cases. One treatment modality cannot be recommended over any other due to the small number of clinical trials and cases included in each study. Further randomized control trials are needed to evaluate the full benefits and shortcomings of each of the different surgical treatment modalities.Indian Journal of Orthopaedics 07/2013; 47(4):323-32. DOI:10.4103/0019-5413.114907 · 0.62 Impact Factor
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ABSTRACT: Radial head fractures represent the most common elbow fractures. Undisplaced fractures usually occur in isolation and can be treated nonsurgically. Displaced fractures should be treated surgically. Simple two-part fractures can easily be handled by osteosynthesis, but comminuted fractures pose a major problem for reconstruction. As the radial head is an important stabilizer of the elbow joint—especially in the context of concomitant ligamentous injuries—its resection may lead to pain, limited range of motion, and instability. Therefore, radial head resection is not recommended for the acute situation and open reduction internal fixation (ORIF) or prosthetic replacement should be aimed for. Complications such as secondary loss of fixation, radial head necrosis, and nonunion due to insufficient stability of the osteosynthesis have often been described. Therefore, prosthetic replacement is recommended if stable reconstruction is impossible. With the development of new locking plates especially designed for the maintenance of radial head fractures, the indications for osteosynthesis may be extended. As radial head fractures are complicated by a high percentage of ligamentous injuries and concomitant elbow fractures such as the coronoid, capitellum, and proximal ulna, these additional injuries have to be taken into account. The current treatment concepts are discussed within this paper.European Journal of Trauma and Emergency Surgery 12/2012; 38(6). DOI:10.1007/s00068-012-0222-x · 0.38 Impact Factor
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ABSTRACT: Objectives Radial head replacement by using a bipolar prosthesis is frequently used when unable to reconstruct fractures of the radial head. The GUEPAR(C) implant is a metallic bipolar prosthesis. The authors describe an uneventful complication of this implant. Four patients have sustained an acute disassembling of the GUEPAR(C) implant after an important grip effort. A biomechanical study was performed in order to explain this disassembling. Method The retention system of the GUEPAR implant has been tested at different temperatures: 4, 20 and 37 degrees C. The stem and the cup were cemented in a support. Disassembling was achieved using a dynamometer. Results The study has shown that the theoretical grip strength leading to disassembling is 145.65 kg at 4 degrees C and 51.45 kg at 37 degrees C. Discussion The polyethylene of the floating head of the implant appears to be very influenced by the temperature. The authors state that the association of a cam effect between the floating cup and the stem with an important grip might lead to the disassembling of the GUEPAR prosthesis. This study shows that the conception of a bipolar implant is very demanding in terms of retention of the floating head on the stem.European Journal of Orthopaedic Surgery & Traumatology 02/2007; 18(2):101-105. DOI:10.1007/s00590-007-0269-2 · 0.18 Impact Factor