Article

Arthroscopic treatment of fractures of the radial head.

Dipartimento di Scienze Ortopediche e Traumatologiche Mario Boni, Facoltà di Medicina e Chirurgia, Università degli Studi dell'Insubria, Varese, Italy.
Arthroscopy The Journal of Arthroscopic and Related Surgery (impact factor: 3.02). 03/2006; 22(2):233.e1-233.e6. DOI:10.1016/j.arthro.2005.10.003 pp.233.e1-233.e6
Source: PubMed

ABSTRACT An original technique for the arthroscopic diagnosis and treatment of the fractures of the radial head is proposed and described. The elbow arthroscopy is started with a 4.5-mm 30 degrees arthroscope from the proximal anteromedial portal and the anterior elbow is examined; then a proximal anterolateral portal is created and a full-radius blade inserted to take out the hematoma and to allow visualization of the radial head that is explored through the whole range of motion to visualize the fracture fragment. The fragment is manipulated by means of arthroscopic tools to reduce the anteromedial surface of the radial head. The arthroscope is now switched to the posterolateral portal and the posterior aspect of the humeral radial joint is visualized. The soft spot portal is used to insert a periosteal elevator to complete the reduction and firmly hold the fragment in the reduced position. An anterolateral portal is now created to allow the safe insertion of a guidewire, angled 45 degrees to the longitudinal axis of the radius, to pierce the fragment with. A 14-mm long cannulated screw is inserted along the guide after specific drilling. Finally, the reduction and the stability of the fixation are checked with during full rotation of the elbow. The described procedure has been performed in 6 patients. Short-term preliminary results show a satisfactory functional outcome. Among the advantages of the technique are the minimally invasive approach, the direct visualization of the fracture, and the benefits derived from the radiation-free procedure.

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    Article: Arthroscopic management of Mason type 2 radial head fractures.
    Frederick Michels, Nicole Pouliart, Frank Handelberg
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    ABSTRACT: During decennia the treatment of radial head fractures has been controversial. For Mason type II fractures, more recent studies agree that open reduction and internal fixation is the treatment of choice. It restores biomechanical properties, allows an early mobilisation of motion and results in better functional outcome compared with other treatments. In this study, we present the mid-to-long-term results of an arthroscopic technique for reduction and percutaneous fixation. Fourteen patients were available for follow-up with a final assessment performed at an average of 5 years 6 months (range 1 year to 11 years 3 months). Patients were evaluated for pain, motion and radiological findings. The average elbow score (Broberg and Morrey in J Bone Joint Surg Am 68:669-674, 1986) was 97.6 points (range 86-100), corresponding with 3 good and 11 excellent results. Two of the patients with only good results had associated cartilage lesions of the capitellum. Our results show that arthroscopically assisted reduction and internal fixation of type II radial head fractures is a valid technique with consistently good outcome. Although the technique is technically demanding, it allows more precise articular fracture reduction control, as well as better evaluation of associated lesions.
    Knee Surgery Sports Traumatology Arthroscopy 11/2007; 15(10):1244-50. · 2.21 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

4.5-mm 30 degrees arthroscope
 
angled 45 degrees
 
anterior elbow
 
anterolateral portal
 
arthroscopic diagnosis
 
arthroscopic tools
 
direct visualization
 
fractures
 
humeral radial joint
 
longitudinal axis
 
minimally invasive approach
 
original technique
 
posterior aspect
 
posterolateral portal
 
proximal anterolateral portal
 
proximal anteromedial portal
 
safe insertion
 
satisfactory functional outcome
 
Short-term preliminary results
 
soft spot portal