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Zhao B, Wang H, Diao S, Xu X, Gao Y, Lu T, Zhou J, Liu Y. Comparison of operatively and nonoperatively treated isolated mason type II radial head fractures: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:540. [PMID: 39227938 PMCID: PMC11373464 DOI: 10.1186/s13018-024-05039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment. METHODS Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes. RESULT A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I2 = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I2 = 0%). CONCLUSION Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications.
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Affiliation(s)
- Binzhi Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China
| | - Hanzhou Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China
| | - Shuo Diao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China
| | - Xiaopei Xu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China
| | - Yulin Gao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China
| | - Tianchao Lu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China
| | - Junlin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China.
| | - Yang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, P.R. China.
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Walker J, Erbulut D, Rebgetz PR, Taylor FJ. Added transverse screw in tripod construct increases stiffness in Mason III radial head fractures: a finite element analysis. J Shoulder Elbow Surg 2024; 33:2022-2032. [PMID: 38599454 DOI: 10.1016/j.jse.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/10/2024] [Accepted: 02/17/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The tripod screw configuration has been shown to offer similar stiffness characteristics to a laterally placed plate. However, concern has been raised that the construct may be prone to failure in scenarios where the screw intersects at the fracture line. We performed a finite element analysis to assess potentially ideal and unideal screw placements in the tripod construct among Mason III radial head fractures. METHODS A 3-dimensional proximal radius model was developed using a computed tomography scan of an adult male radius. The fracture site was simulated with a uniform gap in transverse and sagittal planes creating a Mason type III fracture pattern comprising 3 fragments. Three configurations were modeled with varying screw intersection points in relation to the radial neck fracture line. A fourth configuration comprising an added transverse interfragmentary screw was also modeled. Loading scenarios included axial and shear forces to simulate physiological conditions. Von Mises stress and displacement were used as outcomes for analysis. RESULTS Some variation can be seen among the tripod configurations, with a marginal tendency for reduced implant stress and greater stiffness when screw intersection is further from the neck fracture region. The construct with an added transverse interfragmentary screw demonstrated greater stiffness (2269 N/mm) than an equivalent tripod construct comprising 3 screws (612 N/mm). CONCLUSION The results from this study demonstrate biomechanical similarity between tripod screw constructs including where screws intersect at the radial neck fracture line. An added fourth screw, positioned transversely across fragments, increased construct stiffness in our model.
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Affiliation(s)
- Jared Walker
- University of Queensland, Saint Lucia, QLD, Australia; Herston Biofabrication Institute, Herston, QLD, Australia; Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - Deniz Erbulut
- University of Queensland, Saint Lucia, QLD, Australia; Herston Biofabrication Institute, Herston, QLD, Australia; Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Paul R Rebgetz
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Fraser J Taylor
- Department of Orthopaedic Surgery, The Gold Coast University Hospital, Gold Coast, QLD, Australia
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Pelet S, Hardy A, Tremblay F, Lechasseur B, Rivard-Cloutier M. Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures: A Prospective Cohort Study. J Orthop Trauma 2023; 37:e429-e434. [PMID: 37448159 DOI: 10.1097/bot.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To identify patient-related factors and fracture characteristics influencing the functional outcomes of nonoperatively treated radial head fractures and to determine function at 1 year. DESIGN Prospective cohort study. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016. INTERVENTION Nonoperative treatment of isolated radial head fractures. OUTCOME MEASUREMENTS Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and range of motion at 1.5-3-6-12 months. RESULTS One hundred fourteen patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3], and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with, respectively, 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups ( P < 0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1 year ( P < 0.05). CONCLUSIONS Although most nonoperatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1 year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow for interventions that may optimize function. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stéphane Pelet
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
- Centre de recherche FRQS du CHU de Québec, Québec, QC, Canada
| | - Alexandre Hardy
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Félix Tremblay
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Benoît Lechasseur
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Maude Rivard-Cloutier
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
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Carroll TJ, Dondapati A, Cruse J, Minto J, Hammert WC, Mahmood B. Non-operative Treatment of Mason Type I Radial Head Fractures: A Comparative Analysis Using Patient-Reported Outcomes Measurement Information System (PROMIS). Cureus 2023; 15:e42056. [PMID: 37602006 PMCID: PMC10433034 DOI: 10.7759/cureus.42056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES The purpose of this study is to compare the outcomes of Mason type I radial head fractures. This information will help to provide physicians with a critical decision-making tool when considering non-operative intervention and evaluate Patient-Reported Outcomes Measurement Information System (PROMIS) as a potentially valuable measure to track outcomes. METHODS We retrospectively identified 527 patients undergoing non-operative intervention. Demographic information, physical exam measurements, patient acceptable symptom state (PASS), and PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) scores were analyzed over 12 months. RESULTS At the initial outpatient post-injury visit (within one week of injury), the average PROMIS PF, UE, PI, and Depression were 42.04 (SD: 6.3), 35.31 (SD: 7.3), 59.18 (SD: 9.2), and 48.68 (SD: 6.8), respectively. The average change in PROMIS PF, UE, PI, and Depression scores from the time of injury to six weeks were -0.23 (p=0.7), 1.43 (p=0.03), -2.1 (p=0.01), and -0.99 (p=0.1). The average change in PROMIS PF, UE, PI, and Depression scores from the time of injury to six months was -0.56 (p=0.56), 1.84 (p<0.001), -1.84 (p<0.001), and -0.13 (p=0.68). Among patients initially reporting "not acceptable" on PASS and reporting "acceptable" at the six-month visit, the average PROMIS PF, UE, PI, and Depression scores were 42.14, 38.91, 56.91, and 47.51 respectively. This represents an average difference of 1.11 (p=0.07), 2.82 (p<0.01), -1.19 (p=0.04), and -1.7 (p=0.01) respectively. CONCLUSION PROMIS UE and PI significantly improved among Mason I radial head fractures treated non-operatively at both six-week and six-month follow-up points but did not meet the mean clinically important difference (MCID) PROMIS PF did not significantly differ between the time of injury, six-week or six-month follow-up points. Only PROMIS UE correlated with PASS at six-week and six-month follow-up. Among patients who improved from negative to positive responses on PASS, PROMIS UE, and PI significantly improved.
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Affiliation(s)
| | - Akhil Dondapati
- Orthopaedic Surgery, University of Rochester, Rochester, USA
| | - Jordan Cruse
- Orthopaedic Surgery, University of Rochester, Rochester, USA
| | - Jonathan Minto
- Orthopaedic Surgery, University of Rochester, Rochester, USA
| | | | - Bilal Mahmood
- Orthopaedic Surgery, University of Rochester, Rochester, USA
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Scoscina D, Facco G, Luciani P, Setaro N, Senesi L, Martiniani M, Gigante AP. Mason type III fractures of the radial head: ORIF, resection or prosthetic replacement? Musculoskelet Surg 2023; 107:223-230. [PMID: 35429279 DOI: 10.1007/s12306-022-00745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/26/2022] [Indexed: 05/18/2023]
Abstract
PURPOSE This 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). METHODS The 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. RESULTS Patients 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. CONCLUSION The 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.
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Affiliation(s)
- D Scoscina
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy.
| | - G Facco
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
| | - P Luciani
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
| | - N Setaro
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
| | - L Senesi
- Department of Orthopaedic and Trauma Surgery, Ospedali Riuniti, Ancona, Italy
| | - M Martiniani
- Clinic of Adult and Paediatric Orthopaedics, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - A P Gigante
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/a, 60020, Torrette Di Ancona, Italy
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Barakat A, Mcdonald C, Singh H. Current concepts in the management of radial head fractures: a national survey and review of the literature. Ann R Coll Surg Engl 2023; 105:469-475. [PMID: 36239976 PMCID: PMC10149239 DOI: 10.1308/rcsann.2022.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION This study aims to report on current practice in the management of radial head fractures (RHFs) in the United Kingdom and to review the literature to identify areas for future investigation. METHODS A 12-question online survey was sent to 500 surgeon members of the British Elbow and Shoulder Society in 2021. Questions focused on clinical assessment, indications for surgical treatment and willingness to participate in future studies. Descriptive statistical analysis summarised the responses. RESULTS The response rate was 20.4% (n = 102). For minimally displaced RHFs, non-operative management with immediate mobilisation was reported by 90.2% (n = 92) as opposed to 9.8% (n = 10) for initial immobilisation in plaster or brace. The most cited indication for radial head arthroplasty as opposed to fixation was increased patient age or low functional demand in 69.9% of responses (n = 71). In total, 41.2% (n = 42) indicated the need for a future randomised controlled trial (RCT) concerning the management of RHF. Only five RCTs were returned by the literature review. DISCUSSION There is considerable variability in the management of RHF among an experienced cohort of surgeons. With the interest declared by the participating surgeons, there is a call for a well-designed sufficiently powered RCT.
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Affiliation(s)
- A Barakat
- Kettering General Hospital NHS Foundation Trust, UK
| | - C Mcdonald
- University Hospitals of Leicester NHS Trust, UK
| | - H Singh
- University Hospitals of Leicester NHS Trust, UK
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Alkheraiji AF, Almogbil I, Aljohani M, Albaker AB, Algawahmed H. A Retrospective Study on Traumatic Elbow Dislocation in Adults in a Tertiary Hospital in Riyadh, Saudi Arabia. Cureus 2023; 15:e37554. [PMID: 37193453 PMCID: PMC10183096 DOI: 10.7759/cureus.37554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
Background This retrospective chart review aimed to ascertain the frequency and characteristics of radial head fractures in adults who presented to our emergency department with elbow dislocation. Methodology This study was conducted in a single tertiary trauma center in Riyadh, Saudi Arabia, between July 2015 and July 2020 to identify traumatic elbow dislocation in adults. Patients were identified after thoroughly examining the hospital's electronic X-ray database. In addition, computed tomography (CT) was used to assess complete ulnohumeral joint dislocation. In total, 80 patients between the ages of 18 and 65 were evaluated for a radial head fracture. Various variables were examined. Results Of the 80 patients included, the mean age with standard deviation was 36.9 ± 8.8 years, and all patients were males. Nearly all patients with elbow dislocation had some form of posterior dislocation, including posterolateral (81.3%), posterior (10%), and posteromedial (7.5%) dislocation. The radial head fracture was identified in 48 (60%) cases. Radiographs were sufficient to diagnose 91.3% of radial head fractures, while the remaining 8.8% required additional CT. Conclusions Based on X-ray or CT findings, radial head fractures were found in more than half of traumatic elbow dislocations. In addition, most cases were diagnosed as an elbow dislocation and radial head fracture using only plain radiography, while some required additional CT. Based on these findings, we recommend routine CT to detect suspected elbow dislocation and avoid missing subtle injuries.
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Affiliation(s)
| | - Ismail Almogbil
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Qassim University, Al Qassim, SAU
| | - Moath Aljohani
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Qassim University, Al Qassim, SAU
| | - Abdulmalik B Albaker
- Department of Orthopaedics, College of Medicine, Majmaah University, Majmaah, SAU
| | - Hussain Algawahmed
- Hand, Elbow & Shoulder Surgery, Johns Hopkins Aramco Healthcare, Dhahran, SAU
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Surucu S, Torres KA, Mitchell G, Bachman D, Cheng AL, Cil A, Lee B, Hill BW, Shukla D, Ring D, Boardman D, Kohan E, Alberta F, Kim HM, Vanderbeck J, Barlow JD, Guevara J, Kearns KA, Virk M, Dilisio M, Amini M, Streubel P, Ahmadi S. Decision-making in the treatment of radial head fractures: Delphi methodology. J Shoulder Elbow Surg 2023; 32:364-373. [PMID: 36334862 DOI: 10.1016/j.jse.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/23/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The treatment of partially displaced radial head fractures is determined not only by the type of fracture but also by patient characteristics such as age, occupation, hand dominance, mechanism of injury, and concomitant injuries and comorbidities. The goal of this study was to employ the Delphi method to achieve consensus on the management of patients with radial head fractures, utilizing the experience of the ASES Elbow Fracture-Dislocation Multicenter Study Group and Mayo Elbow Club surgeons. METHODS The initial survey was sent to participants, which included consent to participate in the study and questions about their experience, knowledge, and interest in participating in the Delphi method. We used both open-ended and category-based questions. The second questionnaire generated 76 variables, and individual questions with mean Likert ratings of <2.0 or >4.0 were deemed significant and merged to form multifactorial clinical scenarios relating to both nonoperative and operative management, respectively. RESULTS Of the surgeons who responded to the questionnaire, 64% were from the United States, while the remainder were from overseas practices. Years in practice on average were 12.4 years (range, 1-40). Seven of the 76 factors met the criteria of a mean Likert score of <2.0 or >4.0. These factors were as follows: age, block to the range of motion (ROM) after aspiration/injection, crepitation with ROM, tenderness over the distal radioulnar joint and/or interosseous membrane (dorsal forearm), gap and/or displacement >2 mm on imaging, complete loss of contact of the head with the rest of the radius on imaging, and fracture head involvement 30% on imaging. Twenty-two (46%) of the 96 clinical scenarios gained >90% consensus in favor of surgical treatment, whereas 8 (17%) reached >90% consensus in favor of nonoperative treatment. CONCLUSION Obtaining expert consensus on the treatment of radial head fractures remains challenging. Certain factors such as gap/displacement ≥2 mm without complete loss of contact, ≥30% head involvement with a block to an ROM regardless of tenderness over distal radioulnar joint or interosseous membrane (dorsal forearm), or crepitation when the patient was <80 years of age led to a recommendation of operative treatment in 100% of the surveyed surgeons. Patients older than 80 years with no block to ROM after aspiration/injection, no crepitation with ROM, and no tenderness on distal radioulnar joint/interosseous membrane (dorsal forearm) were recommended for nonoperative treatment regardless of the size of the radial head involvement on imaging.
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Affiliation(s)
- Serkan Surucu
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Mo, USA.
| | - Kabir A Torres
- School of Medicine, University of Missouri-Kansas City, Kansas City, Mo, USA
| | - Garrett Mitchell
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Mo, USA
| | - Daniel Bachman
- Department of Orthopaedic Surgery, Cincinati Children's Hospital, Cincinati, OH, USA
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Mo, USA
| | - Akin Cil
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Mo, USA
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Zhang D, Dyer GSM, Earp BE, Blazar P. Complications, Reoperations, and Long-Term Outcomes after Open Reduction Internal Fixation of Mason Classification Type II and Type III Radial Head Fractures. J Hand Microsurg 2023; 15:45-52. [PMID: 36761044 PMCID: PMC9904971 DOI: 10.1055/s-0041-1724223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction The objectives of this study were to assess long-term outcomes, complications, and reoperations after open reduction internal fixation (ORIF) of radial head fractures. Materials and Methods 35 adult patients, who underwent ORIF of an isolated, displaced radial head fracture without elbow instability (Mason classification type II or III) at two tertiary care referral centers from 2000 to 2017, were identified. Patient satisfaction, pain, and QuickDASH scores were assessed by telephone follow-up at median 12.9 years. Results The mean age of the 35 patients in our study was 39 years, and 54% were women. The median length of clinical follow-up was 175 days. Postoperative complications occurred in 54% of patients, and reoperations in 23% of patients. Multivariable logistic regression identified fixation with plate and screws versus screws alone as a risk factor for complications and reoperations. The long-term telephone follow-up response rate was 54%. At 13-year median follow-up, the average patient satisfaction was 9.6/10, the average patient-reported pain was 0.7/10, and the average QuickDASH score was 10.5. Conclusion The long-term outcomes of ORIF of Mason classification type II and III radial head fractures are favorable; however, rates of complication and reoperation are notable and may be higher with plate-and-screw fixation.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - George S. M. Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Brandon E. Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
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Model Z, Merchan N, Rozental TD, Harper CM. Outcomes of Radial Head Fractures Treated With the "Tripod Technique". J Hand Surg Am 2022; 47:582.e1-582.e5. [PMID: 34332815 DOI: 10.1016/j.jhsa.2021.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/17/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE For fractures requiring operative fixation, the "tripod technique" using headless compression screws has recently been described as a less invasive alternative to open reduction and internal fixation with plate and screws. The purpose of this study was to evaluate the clinical and radiographic outcomes of the tripod technique for the treatment of radial head and neck fractures. METHODS We performed a retrospective chart review of all radial head and neck fractures treated with the tripod technique at our institution over a 10-year period. Patients with less than 6 months of follow-up were excluded. Outcomes were evaluated at the latest follow-up using range of motion measurements and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. RESULTS We evaluated 13 patients with a mean age of 48 years and average follow-up of 72 months (range, 21-153 months). All the patients achieved union by 12 weeks after surgery. The average postoperative Quick Disabilities of the Arm, Shoulder and Hand score was 5.9 (range, 0-23). The mean flexion was 139°, and the mean extension was -8°. There were no major postoperative complications. Five patients had minor complications. No patients required a reoperation. CONCLUSIONS The tripod technique is a useful alternative to the traditional method of plate and screw fixation for unstable radial head and neck fractures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Zina Model
- Harvard Combined Orthopaedic Residency Program, Boston, MA
| | - Nelson Merchan
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Tamara D Rozental
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Carl M Harper
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.
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Pathak SK, Salunke AA, Chawla JS, Sharma A, Ratna HVK, Gautam RK. Bilateral Radial Head Fracture Secondary to Weighted Push-Up Exercise: Case Report and Review of Literature of a Rare Injury. Indian J Orthop 2022; 56:162-167. [PMID: 35070157 PMCID: PMC8748555 DOI: 10.1007/s43465-021-00427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/13/2021] [Indexed: 02/04/2023]
Abstract
A 33-year-old male presented with bilateral radial head fractures after weighted prone push-up exercise. The patient had Mason type I and II on right and left sides, respectively. He was managed conservatively with limited immobilisation and early range of motion exercises. The fracture healed and patient had no complaints at the last follow-up of 13 months. Bilateral radial head fracture is rare with push-up exercise, and can be successfully treated conservatively with immobilisation and early rehabilitation. Although push-up exercises are an excellent workout with known benefits, unusual modifications of standard techniques should be avoided.
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Affiliation(s)
- Subodh Kumar Pathak
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | | | - Jasneet Singh Chawla
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | - Aryan Sharma
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | - Harish V. K. Ratna
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
| | - Rakesh Kumar Gautam
- Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, MM (Deemed to be University), Ambala, India
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12
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Mulders MAM, Schep NWL, de Muinck Keizer RJO, Kodde IF, Hoogendoorn JM, Goslings JC, Eygendaal D. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30:1670-1678. [PMID: 33753275 DOI: 10.1016/j.jse.2021.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal treatment of isolated displaced partial articular radial head fractures remains controversial. The aim of this randomized controlled trial was to compare the functional outcome of operative treatment with nonoperative treatment in adults with an isolated Mason type 2 radial head fractures. METHODS In this multicenter randomized controlled trial, patients from 18 years of age with an isolated partial articular fracture of the radial head were randomly assigned to operative treatment by means of open reduction and screw fixation or nonoperative treatment with a pressure bandage. The primary outcome was function assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Questionnaires and clinical follow-up was conducted at admission and at 3, 6, and 12 months. RESULTS In total, 45 patients were randomized, 23 patients to open reduction and screw fixation and 22 patients to nonoperative treatment with a pressure bandage. At 3, 6, and 12 months, patients treated operatively had similar functional outcomes compared to patients treated nonoperatively (DASH score at 12 months: 0.0 [0.0-4.2] vs. 1.7 [0.0-8.5]; P = .076). CONCLUSIONS Nonoperatively treated adults with an isolated Mason type 2 radial head fracture have similar functional results after 1 year compared with operatively treated patients. In addition, complication rates were low for both operative and nonoperative treatment.
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Affiliation(s)
- Marjolein A M Mulders
- Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
| | - Niels W L Schep
- Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Izaäk F Kodde
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Deventer Hospital, Deventer, the Netherlands
| | | | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
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13
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Luchetti TJ, Newsum N, Bohl DD, Cohen MS, Wysocki RW. Radiographic evaluation of partial articular radial head fractures: assessment of reliability. JSES Int 2021; 5:782-788. [PMID: 34223430 PMCID: PMC8245995 DOI: 10.1016/j.jseint.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background Historically, treatment of partial articular radial head fractures has hinged on radiographic assessment and application of the Mason classification. The inter- and intra-rater reliability of radiographic assessment and classification of radial head fractures may be lower than previously reported. We hypothesized that radiographic assessment leads to an underestimation of the number of fragments, percentage of articular surface involved, and displacement in millimeters. Methods We performed a retrospective review of all Mason II radial head fractures treated at our institution. Four independent observers performed radiographic assessment of the cohort. An independent observer performed these measurements on high-resolution computed tomography (CT) imaging, the reference standard. Radiographic assessments were then correlated with the CT findings using Pearson's correlation coefficient and Kappa statistic, where indicated. Results Fifty-nine Mason II radial head fractures were reviewed. These results were not impressive, with all comparisons showing a Kappa statistic less than 0.5 (ie, weak agreement). Intra-rater reliability was similar: displacement (measured by Pearson's correlation coefficient) was 0.58, percent articular involvement was 0.74, and the number of fragments (measured by the Kappa statistic) was 0.28. Fracture displacement was generally underestimated on radiographic measurements when compared to CT scan. Nearly half (45%) of all cases demonstrated inaccurate fragment number assessment when compared to the reference standard. Conclusion Radiographs show poor inter- and intra-observer reliability for determining radial head fracture morphology. Assessment of the number of fragments was particularly inaccurate. High-resolution CT should be considered for patients with Mason II radial head fractures, especially in cases of poorly visualized fracture characteristics or borderline amounts of displacement, in an effort to appropriately indicate patients for the variety of treatment options available today.
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Affiliation(s)
- Timothy J Luchetti
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Nicholas Newsum
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Daniel D Bohl
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Mark S Cohen
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Robert W Wysocki
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
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14
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Lanzerath F, Hackl M, Wegmann K, Müller LP, Leschinger T. The treatment of isolated Mason type II radial head fractures: a systematic review. J Shoulder Elbow Surg 2021; 30:487-494. [PMID: 33197586 DOI: 10.1016/j.jse.2020.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the radial head represent the most common bony injury of the elbow in adults. Radial head fractures are classified according to Mason or one of its classification modifications. Current literature does not indicate consensus on whether to treat isolated stable type II radial head fracture patterns with open reduction and internal fixation (ORIF) or nonoperatively, especially, when there is no mechanical block to motion. METHODS We systematically reviewed the available literature searching electronic databases, that is, MEDLINE using the PubMed interface and Embase, for studies published between 2011 and 2020. The primary objective was to contrast the outcome scores of these 2 different study groups and the pitfalls accompanied with the 2 different approaches. The PRISMA guidelines were applied. RESULTS The literature search left 11 studies for inclusion, all but 1 retrospective in design, comprising 319 patients. A total of 218 patients (68.3%) were treated with ORIF and 101 patients (31.7%) were treated nonoperatively. Our findings indicate that ORIF does not provide better results when compared to nonoperatively treated patients concerning functional outcome parameters. Treatment success, defined as excellent or good results according to the Mayo Elbow Performance Score or the Broberg and Morrey score, among the patients treated with ORIF was 90.9%; 7.1% were in need of subsequent surgery and 5.2% had radiologic osteoarthritic changes of the radial column. In addition, 95.1% of the nonoperative cohort were treated successfully, and osteoarthritis was present in 11.9%. Mean follow-up period of the ORIF and the nonoperative cohort was 73 and 39 months, respectively. CONCLUSION ORIF and nonoperative treatment of isolated Mason type II radial head fractures provide comparably satisfactory functional outcomes, without significant differences. Consideration of age, activity level and potential risks is recommended before making any treatment decision. Subsequent surgery rates were higher for patients treated with ORIF than for those treated nonoperatively and should be discussed. However, development of osteoarthritis of the radial column appears to be more likely after nonoperative treatment. The study pool remains limited, and implications of this review should be handled with caution.
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Affiliation(s)
- Fabian Lanzerath
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
| | - Michael Hackl
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Kilian Wegmann
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Lars P Müller
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Tim Leschinger
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
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15
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Abstract
Radial head fractures are a common fracture involving the elbow joint. Patients typically present after a fall onto an outstretched hand with elbow pain and swelling. Without adequate treatment, this can lead to long-term complications, including loss of elbow motion and pain. Radial head fractures may also be associated with other injuries including elbow dislocation, neighbouring bony fractures and associated ligamentous rupture. It is therefore imperative that hospital clinicians understand the diagnosis and treatment of this condition. The plain radiograph is the optimum method to diagnose a radial head fracture. These fractures can be managed using a variety of techniques, from non-surgical conservative methods for the undisplaced fracture through to surgical fixation, radial head replacement and excision for the more complex, displaced fracture.
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Affiliation(s)
- Haseeb Khawar
- Department of Trauma and Orthopaedics, Queen's Medical Centre, Nottingham, UK
| | - Simon Craxford
- Department of Trauma and Orthopaedics, Queen's Medical Centre, Nottingham, UK
| | - Benjamin Ollivere
- Department of Trauma and Orthopaedics, Queen's Medical Centre, Nottingham, UK.,School of Medicine, University of Nottingham Medical School, Nottingham, UK
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16
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Lee YS, Kang YH, Chung YG, Shin SH. Open reduction and internal fixation for Mason type III radial head fractures: Is it different from that for Mason type II fractures? J Orthop Surg (Hong Kong) 2019; 26:2309499018802506. [PMID: 30270793 DOI: 10.1177/2309499018802506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The objective of this study was to investigate whether the outcomes of Mason type III radial head fractures (RHFs) treated by open reduction and internal fixation (ORIF) were comparable to those of Mason type II RHFs treated by ORIF. METHODS A total of 87 surgically treated RHF patients were reviewed. Their fractures were Mason type II in 39 patients (all treated by ORIF) and Mason type III in 48 patients (40 treated by ORIF, 7 by radial head arthroplasty, and 1 by resection). Although ORIF was preferred for Mason type III RHFs in our series, an arthroplasty was performed when the fracture accompanied severe associated injuries or multiple traumas. Radiological and functional outcomes were evaluated and complications were reviewed. RESULTS When Mason type II and Mason type III in general were compared, QuickDASH score, a shortened version of the Disabilities of the Arm, Shoulder and Hand (DASH) score, and forearm rotation were significantly worse in Mason type III. However, when comparing Mason type II and Mason type III treated by ORIF in which the proportion of associated injuries were not significantly different, there was no significant difference in QuickDASH score, range of extension/flexion, or complication rate. Forearm rotations were significantly more limited in Mason type III treated by ORIF (7° for pronation and 7° for supination), and Mason type had an independent effect on forearm rotations in multivariate analysis. CONCLUSION ORIF for Mason type III fractures with low level of associated injury can be as good as that for Mason type II fractures, except for less forearm rotation.
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Affiliation(s)
| | | | | | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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17
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Gao X, Yin H, Lu J. [Closed reduction and internal fixation with elastic nail for Mason type Ⅱ radial head fracture in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:981-985. [PMID: 31407557 DOI: 10.7507/1002-1892.201903117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of closed reduction and internal fixation with elastic nails in treatment of Mason type Ⅱ radial head fracture in adults. Methods A clinical data of 28 patients with Mason type Ⅱ radial head fractures between May 2013 and March 2017 was retrospectively analyzed. Thirteen patients were treated with closed reduction and internal fixation with elastic nails (trial group); 15 patients were treated with open reduction and internal fixation with Herbert screws (control group). There was no significant difference in gender, age, cause of injury, side of fracture, and the time from injury to operation between the two groups ( P>0.05). The operation time, blood loss, and fluoroscopy times in the two groups were recorded and compared. Postoperative X-ray films were used to evaluate the bone healing, heterotopic ossification, and necrosis of radial head. The effectiveness was evaluated according to Mayo score criteria of the elbow at last follow-up. Results All patients were followed up 12-30 months (mean, 21.9 months). The operation time and blood loss were significantly less in the trial group than in the control group ( P<0.05), while the fluoroscopy times significantly increased in the trial group than in the control group ( P<0.05). X-ray films showed that all fractures healed with the bone healing time of (2.85±0.69) months in the trial group and (3.35±0.88) months in the control group. There was no significant difference in bone healing time between the two groups ( t=1.654, P=0.110). Heterotopic ossification occurred in 2 cases in the control group. At last follow-up, there was no significant difference in the Mayo scores between the trial group (90.6±5.3) and the control group (86.4±7.1) ( t=1.750, P=0.092). Conclusion Closed reduction and internal fixation with elastic nails, as a minimally invasive technique, has advantages of short operation time and less bleeding in the treatment of Mason type Ⅱ radial head fracture.
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Affiliation(s)
- Xu Gao
- Qingdao University, Qingdao Shandong, 266071, P.R.China;Department of Orthopedics, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266071, P.R.China
| | - Hailei Yin
- The Second Department of Orthopedics, No.401 Hospital of the Chinese PLA, Qingdao Shandong, 266071,
| | - Jianfeng Lu
- The Second Department of Orthopedics, No.401 Hospital of the Chinese PLA, Qingdao Shandong, 266071, P.R.China
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18
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Hak Roh Y, Kim S, Sik Gong H, Hyun Baek G. WITHDRAWN: Internal fixation of unstable radial head fracture: A comparison of metallic and biodegradable implants. Injury 2019:S0020-1383(19)30460-7. [PMID: 31416602 DOI: 10.1016/j.injury.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 02/02/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, South Korea.
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Sungnam 13620, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
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19
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Fenoglio AK, Stephens AR, Zhang C, Presson AP, Tyser AR, Kazmers NH. Evaluating the Utility of Follow-up Radiographs for Isolated Radial Head Fractures Undergoing Initial Nonoperative Treatment. J Orthop Trauma 2019; 33:e291-e295. [PMID: 31335568 PMCID: PMC6658122 DOI: 10.1097/bot.0000000000001489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the utility of follow-up radiographs in patients with isolated partial articular radial head fractures (OTA/AO 2R1B1 or 2R1B3). DESIGN Retrospective cohort study. SETTING Academic Level 1 Trauma Center. PATIENTS Adult patients (≥18 years) with isolated partial articular radial head fractures indicated for initial nonoperative treatment. INTERVENTION Analysis of elbow radiographs at initial presentation and at postinjury follow-up of 3-8 weeks. VARIABLES MEASURED Articular gap and step-off. MAIN OUTCOME MEASURE Radiographic articular displacement between initial and follow-up radiographs. RESULTS For 72 included patients, initial radiographs were obtained on average 2.6 days after injury and follow-up radiographs 33.7 days thereafter. Equivalence tests evaluating gap and step-off thresholds of <1 mm were both significant, indicating that the cohort displaced <1 mm for both parameters between initial and follow-up radiographs. No patients proceeded to surgical treatment following the repeat radiographs. CONCLUSIONS These fractures do not displace in the early postinjury period, as defined as a <1 mm of change in both intra-articular gap and step-off, as compared to initial radiographs. Routine follow-up radiographs for these injuries is a source of cost, but with limited utility in detecting interval displacement or leading to a change in management. Selective use of radiographs to evaluate specific clinical concerns may lead to cost savings. LEVEL OF EVIDENCE Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amy K. Fenoglio
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| | - Andrew R. Stephens
- University of Utah, School of Medicine, 30N 1900E, Salt Lake City, UT 84132
| | - Chong Zhang
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT 84108
| | - Angela P. Presson
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT 84108
| | - Andrew R. Tyser
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| | - Nikolas H. Kazmers
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
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Hackl M, Wegmann K, Hollinger B, El-Zayat BF, Seybold D, Gühring T, Schnetzke M, Schmidt-Horlohé K, Greiner S, Lill H, Ellwein A, Glanzmann MC, Siebenlist S, Jäger M, Weber J, Müller LP. Surgical revision of radial head fractures: a multicenter retrospective analysis of 466 cases. J Shoulder Elbow Surg 2019; 28:1457-1467. [PMID: 30713065 DOI: 10.1016/j.jse.2018.11.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head fractures lead to persisting disability in a considerable number of cases. This study aimed to investigate their most common revision causes and procedures. METHODS This multicenter retrospective study reviewed the cases of 466 adult patients who had undergone surgical revision after operative or nonoperative treatment of a radial head fracture. The initial diagnosis was a Mason type I fracture in 13.0%, Mason type II fracture in 14.6%, Mason type III fracture in 22.8%, Mason type IV fracture in 20.9%, terrible-triad injury in 12.8%, Monteggia-like lesion in 13.1%, and Essex-Lopresti lesion in 2.0%. Initial treatment was nonoperative in 30.2%, open reduction and internal fixation (ORIF) in 44.9%, radial head arthroplasty in 16.6%, radial head resection in 3.7%, sole treatment of concomitant injuries in 2.6%, and fragment excision in 2.0%. Up to 3 revision causes and procedures were recorded per case. RESULTS The most common complications were stiffness (67.4%), instability (36.5%), painful osteoarthritis (29.2%), ORIF related (14.8%), nonunion or necrosis (9.2%), radial head arthroplasty related (7.5%), ulnar neuropathy (6.0%), and infection (2.6%). Revision procedures frequently included arthrolysis (42.1%), arthroplasty (24.9%), implant removal (23.6%), ligament repair or reconstruction (23.0%), débridement (14.2%), repeated ORIF (8.2%), and/or radial head resection (7.7%). Mason type I or II fractures were primarily revised because of stiffness and painful osteoarthritis. Complications after Mason type III fractures were predominantly ORIF related. Fracture-dislocations showed a wide range of complications, with instability and stiffness comprising the most common causes of revision. CONCLUSIONS The complications of radial head fractures are characteristic to their classification. Knowledge of these findings might guide surgeons in treating these injuries and may help counsel patients accordingly.
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Affiliation(s)
- Michael Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - Boris Hollinger
- Ellenbogen- und Schulterchirurgie, Arcus Sportklinik, Pforzheim, Germany
| | - Bilal F El-Zayat
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thorsten Gühring
- Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen, Germany
| | - Marc Schnetzke
- Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen, Germany
| | | | | | - Helmut Lill
- Department of Orthopedics and Traumatology, Diakovere Friederikenstift, Hanover, Germany
| | - Alexander Ellwein
- Department of Orthopedics and Traumatology, Diakovere Friederikenstift, Hanover, Germany
| | | | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Münich, Münich, Germany
| | - Martin Jäger
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Jörg Weber
- Department of Trauma Surgery, Orthopedics and Hand Surgery, Südstadt Hospital Rostock, Rostock, Germany
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
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Rebgetz PR, Daniele L, Underhill ID, Öchsner A, Taylor FJ. A biomechanical study of headless compression screws versus a locking plate in radial head fracture fixation. J Shoulder Elbow Surg 2019; 28:e111-e116. [PMID: 30685273 DOI: 10.1016/j.jse.2018.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Fixation of a 3-part radial head fracture with cannulated compression screws will show equivalent stiffness to a locking plate under axial load. Debate exists regarding the management of Mason type III fractures, with many believing that open reduction and internal fixation provides advantages over other options. By virtue of their subarticular placement, screw fixation is less likely to cause impingement compared with plate fixation, which can result in loss of rotation and requirement for hardware removal. Insufficient fixation stability can lead to nonunions, necrosis of the radial head, pain, and instability. We tested the mechanical stability of fixation of simulated radial head fractures using headless compression screws compared with standard plate construct. METHODS Standardized test constructs were created with repeatable osteotomy cuts and hardware placement on each Synbone model (Synbone AG, Malans, Switzerland). We presectioned 22 proximal radius Synbone models to simulate a 3-part radial head fracture. The models were fixed using a radial head locking plate or headless compression screws in a tripod construct. The constructs were potted into a compression test jig using 2-part epoxy resin. Compression testing was performed using a 30-kN Instron Universal machine (Instron, Norwood, MA, USA). The compression tool was spherical, representing the surface of the capitellum. RESULTS There was no significant difference between the stiffness of the Synbone constructs under axial load. CONCLUSION There was no significant difference between fixation stiffness of a 3-part radial head fracture with headless compression screws in a tripod structure vs. a locking plate in Synbone. Further study is required to allow clinical application.
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Affiliation(s)
- Paul R Rebgetz
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia.
| | - Luca Daniele
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Ian D Underhill
- Department of Engineering, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Andreas Öchsner
- Department of Engineering, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Fraser J Taylor
- Department of Orthopaedics, The Gold Coast University Hospital, Gold Coast, QLD, Australia
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Vannabouathong C, Akhter S, Athwal GS, Moro J, Bhandari M. Interventions for displaced radial head fractures: network meta-analysis of randomized trials. J Shoulder Elbow Surg 2019; 28:578-586. [PMID: 30626538 DOI: 10.1016/j.jse.2018.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/04/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to conduct a systematic review of studies comparing treatments for displaced radial head fractures (RHFs) and perform a network meta-analysis of randomized controlled trials (RCTs). METHODS We searched electronic databases and reviewed the reference lists of included studies and prior systematic reviews. We included RCTs and cohort studies that (1) compared treatments for displaced RHFs in adults and (2) reported a functional outcome or postoperative complications. Data from RCTs were synthesized using a Bayesian network meta-analysis. We compared the proportion of patients categorized as "excellent" or "good" according to the Broberg and Morrey scale and the rate of postoperative complications using odds ratios (OR) with 95% credible intervals (CrI). RESULTS We included 20 studies (4 RCTs). The evidence from RCTs examined radial head arthroplasty (RHA), open reduction and internal fixation (ORIF) with metal implants (ORIF-M), and ORIF with biodegradable implants (ORIF-B). The network meta-analysis demonstrated that patients treated with an RHA had greater odds of achieving an "excellent" or "good" score compared with ORIF-M (OR, 22.5; 95% CrI, 2.73-299.58) and ORIF-B (OR, 11.83; 95% CrI, 0.58-324.57). For postoperative complications, RHA patients had a lower odds of experiencing a complication than ORIF-M (OR, 0.15; 95% CrI, 0.01-1.81) and ORIF-B (OR, 0.16; 95% CrI, 0.01-3.06) patients. CONCLUSION The network meta-analysis of RCTs indicated that RHA results in better function and reduced postoperative complications than ORIF-M and ORIF-B over 2 years in the treatment of displaced RHFs.
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Affiliation(s)
| | - Shakib Akhter
- Department of Health, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - George S Athwal
- Department of Surgery, Western University, London, ON, Canada
| | - Jaydeep Moro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Instabilität nach operativer und konservativer Versorgung von isolierten Mason-II-Frakturen. Unfallchirurg 2018; 122:219-224. [DOI: 10.1007/s00113-018-0504-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Background: Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries. Methods: A literature search was performed and the authors’ personal experiences are reported. Results: Mason type I fractures are treated non-operatively with splinting and early mobilisation. The management of Mason type II injuries is less clear with evidence supporting both non-operative treatment and internal fixation. The degree of intra-articular displacement and angulation acceptable for non-operative management has yet to be conclusively defined. Similarly the treatment of type III and IV fractures remain controversial. Traditional radial head excision is associated with valgus instability and should be considered only for patients with low functional demands. Comparative studies have shown improved results from internal fixation over excision. Internal fixation should only be attempted when anatomic reduction and initiation of early motion can be achieved. Authors have reported that results from fixation are poorer and complication rates are higher if more than three fragments are present. Radial head arthroplasty aims to reconstruct the native head and is indicated when internal fixation is not feasible and in the presence of complex elbow injuries. Overstuffing of the radiocapitellar joint is a frequent technical fault and has significant adverse effects on elbow biomechanics. Modular design improves the surgeon’s ability to reconstruct the native joint. Two randomised controlled trials have shown improved clinical outcomes and lower complication rate following arthroplasty when compared to internal fixation. Conclusion: We have presented details regarding the treatment of various types of radial head fractures - further evidence, however, is still required to provide clarity over the role of these different management strategies.
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Martin DP, Wilt ZT, Cantlon MB, Wang ML. Controversies Surrounding the Management of the Isolated Type-II Radial-Head Fracture. JBJS Rev 2017; 5:e3. [DOI: 10.2106/jbjs.rvw.17.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Crönlein M, Zyskowski M, Beirer M, Imhoff FB, Pförringer D, Sandmann GH, Kirchhoff C, Biberthaler P, Siebenlist S. Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 2017; 137:789-795. [PMID: 28432459 DOI: 10.1007/s00402-017-2693-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION For comminuted and displaced fractures of the radial head open reduction and internal fixation (ORIF) is recommended nowadays as the treatment of choice. Due to the development of locking plates the possibilities of ORIF in complex fracture types were extended. The purpose of this retrospective survey therefore was to review the preliminary subjective and objective results in patients treated by anatomically preshaped locked plating. A reliable fracture healing for these recently introduced plating devices was hypothesized. MATERIALS AND METHODS Subjective and objective criteria included patient's satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey elbow performance score (MEPS), the QuickDASH and the elbow self-assessment score (ESAS). Furthermore, follow-up radiographs were reviewed. RESULTS Between 2011 and 2014 a total of 24 patients were managed with ORIF using anatomically preshaped low-profile locking plates. All patients had suffered from comminuted radial head fractures (type III-IV according to Mason classification). Twenty of 24 patients returned for follow-up examination after a mean of 30 months (range 18-53 months). Patients' satisfaction was rated as highly satisfied in 17 cases and satisfied in 3 cases. An unrestricted ROM for extension-flexion arc and pronation-supination arc was rated in 10 cases. Minor ROM deficiencies with a 5° limited extension compared to the contralateral side was evaluated in 6 cases. Only four patients were rated with and extension and supination deficiency of 10°, one of whom with an additional pronation deficiency of 10°. The calculated MEPS was Ø 98 ± 4 (range 85-100), and the QuickDASH was Ø 3 ± 6 (range 0-21). The ESAS was completed by 18 patients with a mean of Ø 96.54 ± 2.95 (range 94-100) indicating a non-restricted elbow function. CONCLUSIONS The treatment of comminuted radial head fractures using anatomically preshaped locking radial head plates represents a reliable and safe surgical approach, leading to good to excellent functional results. Being aware of the importance of the radial head for elbow stability, open reduction and internal fixation should be preferred prior to radial head resection or replacement in complex radial head fractures. Further trials with a higher number of patients are needed to confirm the advantages of preshaped radial head plates.
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Affiliation(s)
- Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Florian B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Shetty SK, Shetty A, Balan B, Ballal A, Rai H, Hegde A. Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques. J Clin Diagn Res 2017; 11:RC01-RC03. [PMID: 28384945 PMCID: PMC5376771 DOI: 10.7860/jcdr/2017/22051.9379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The management of displaced and comminuted radial head fractures has been a matter of debate amongst surgeons for many years. Radial head excision formed the mainstay of surgical management of these injuries. Over the years, there have been improvements in the surgical techniques and availability of better implants and instrumentation techniques, hence, open reduction and internal fixation of these fractures is gaining popularity. AIM To compare the outcome of elbow function between radial head excision and open reduction and internal fixation of the radial head with mini screws of Mason Type II and Type III radial head fractures and to assess the complications that occur in both techniques. MATERIALS AND METHODS A prospective study was conducted in the Department of Orthopaedic Surgery of Justice K.S.Hegde Charitable hospital. A total of 40 patients between the age group of 30-50 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. Group I consisted of 20 patients who underwent radial head excision and Group II consisted of 20 patients who underwent open reduction and internal fixation with mini screws. Patients were reviewed at postoperative week 3, 6 and 24. Radiographs were taken and functional outcome assessment of the elbow was done during all the follow ups. Elbow physiotherapy was started on postoperative week three. Scoring of elbow function was done as per the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. Results were tabulated, compared and analysed statistically using the 'chi-square test'. RESULTS At the end of six months, the patients of the open reduction and internal fixation group had lower DASH scores (4.82±2.73 points) than the radial head excision group (14.23±5.60 points). This inferred that patients who underwent open reduction and internal fixation had better functional outcomes than the excision group. Complications of proximal radial migration was noted in three patients, elbow osteoarthritis was noted in two and periarticular ossification was noted in six patients who underwent radial head excision. CONCLUSION Open reduction and internal fixation of Mason Type II and Type III radial head fractures is a better management technique as compared to radial head excision for management of Mason Type II and III radial head fractures.
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Affiliation(s)
- Sanath Kumar Shetty
- Assistant Professor, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Ashwin Shetty
- Associate Professor, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Bijith Balan
- Postgraduate, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Arjun Ballal
- Registrar, Department of Orthopaedic Surgery, ARS Hospital, Tirupur, Tamil Nadu, India
| | - H.Ravindranath Rai
- Professor and Head, Department of Orthopaedic Surgery, K.S.Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India
| | - Anoop Hegde
- Registrar, Department of Orthopaedic Surgery, ARS Hospital, Tirupur, Tamil Nadu, India
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Hagelberg M, Thune A, Krupic F, Salomonsson B, Sköldenberg O. Functional outcome after Mason II-III radial head and neck fractures: study protocol for a systematic review in accordance with the PRISMA statement. BMJ Open 2017; 7:e013022. [PMID: 28132003 PMCID: PMC5278296 DOI: 10.1136/bmjopen-2016-013022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Fractures of the radial head and neck are the most common fractures of the elbow, and account for approximately one-third of all elbow fractures. Depending on the fracture type the treatment is either conservative or surgical. There is no absolute consensus regarding optimal treatment for different fracture types. The aim of this protocol is to present the method that will be used to collect, describe and analyse the current evidence regarding the treatment of Mason II-III radial head and neck fractures. METHOD AND ANALYSIS We will conduct a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines statement. We will search a number of databases with a predefined search strategy to collect both randomised and non-randomised studies. The articles will be summarised with descriptive statistics. If applicable a meta-analysis will be conducted. ETHICS AND DISSEMINATION Ethical approval is not required since this is a protocol for a systematic review and no primary data will be collected. The authors will publish findings from this review in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER CRD42016037627.
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Affiliation(s)
- Mårten Hagelberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Alexandra Thune
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Ferid Krupic
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Akademy, University of Gothenburg, Mölndal, Sweden
| | - Björn Salomonsson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Guzzini M, Vadalà A, Agrò A, Di Sanzo V, Pironi D, Redler A, Serlorenzi P, Proietti L, Civitenga C, Mazza D, Lanzetti RM, Ferretti A. Nonsurgical treatment of Mason type II radial head fractures in athletes. A retrospective study. G Chir 2017; 37:200-205. [PMID: 28098055 DOI: 10.11138/gchir/2016.37.5.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The best treatment for moderately displaced radial head fractures (Mason type II) still remains controversial. In cases of isolated fractures, there is no evidence that a fragment displacement of ≥ 2 mm gives poor results in conservatively treated fractures. PATIENTS AND METHODS We retrospectively reviewed 52 patients (31M, 21F) affected by an isolated Mason type II fracture, treated with a long arm cast for two weeks between 2008 and 2013. All patients had practiced sports before being injured. They were all either bicyclists, or baseball, boxers, basketball, rugby, tennis or football players. The mean follow-up was 36 months. Elbow and forearm range of motion were measured. The Mayo Elbow Performance Score, the Broberg and Morrey rating system and the Disabilities of the Arm, Shoulder and Hand Score (DASH score) were analyzed. Follow-up radiographs were examined for evidence of consolidation, late displacement, early arthritis and non-unions. RESULTS Flexion was slightly impaired in the injured limb when compared to the uninjured limb (137°± 6° versus 139°±5°) as were extension (-3°±6° versus 1°±4°, p < 0.05), supination (86°±6° versus 88°±3°), pronation (87°±4° versus 88°±6°) and valgus deviation (10°±4° versus 8°±3°, p < 0.05). 40 patients had no elbow complaints; 9 patients experienced occasional pain, 2 a mild instability of the elbow, and 4 a mild loss of grip strength. The DASH score was excellent in 48 patients (92.31%). In only 6 cases (11.53%) degenerative changes were greater in formerly injured elbows than in uninjured elbows. All patients returned to their previous sports activities. CONCLUSIONS Isolated Mason type II fractures can have a good or excellent mid-term functional outcome even when treated conservatively.
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Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:283-91. [DOI: 10.1007/s00590-016-1739-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/05/2016] [Indexed: 11/27/2022]
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Kodde IF, Kaas L, Flipsen M, Bekerom MPJVD, Eygendaal D. Current concepts in the management of radial head fractures. World J Orthop 2015; 6:954-960. [PMID: 26716091 PMCID: PMC4686442 DOI: 10.5312/wjo.v6.i11.954] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/22/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Fracture of the radial head is a common injury. Over the last decades, the radial head is increasingly recognized as an important stabilizer of the elbow. In order to maintain stability of the injured elbow, goals of treatment of radial head fractures have become more and more towards restoring function and stability of the elbow. As treatment strategies have changed over the years, with an increasing amount of literature on this subject, the purpose of this article was to provide an overview of current concepts of the management of radial head fractures.
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Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 2014; 96:1716-23. [PMID: 25320198 DOI: 10.2106/jbjs.m.01354] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management. METHODS From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006). CONCLUSIONS Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Neil R Wickramasinghe
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Nicholas D Clement
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
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Yoon A, King GJW, Grewal R. Is ORIF superior to nonoperative treatment in isolated displaced partial articular fractures of the radial head? Clin Orthop Relat Res 2014; 472:2105-12. [PMID: 24577616 PMCID: PMC4048435 DOI: 10.1007/s11999-014-3541-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While good results have been reported with both nonoperative and operative treatment of isolated displaced partial radial head fractures, there remains considerable disagreement about the role of surgery in the management of these injuries. QUESTIONS/PURPOSES We (1) compared isolated displaced partial articular radial head fractures treated nonoperatively with open reduction internal fixation (ORIF) in terms of validated outcomes scores, ROM, and strength; (2) assessed whether there were any predictor variables for outcomes; and (3) compared complications between groups. METHODS We retrospectively compared patients with isolated partial articular radial head fractures displaced greater than 2 mm but less than 5 mm who received either nonoperative treatment (30 patients) or ORIF (30 patients). We reviewed the nonoperative and ORIF groups at a mean of 3 and 4.5 years, respectively. The nonoperative and ORIF groups were similar except for age (51 ± 17 years versus 39 ± 10 years, respectively) and fracture displacement (2.3 ± 0.3 mm versus 2.8 ± 0.6 mm, respectively). As there were no definitive guidelines on which treatment represented best management, treatment type was decided by the attending surgeon in conjunction with the patient on a case-by-case basis. Patients were evaluated using the Patient-rated Elbow Evaluation (PREE) (primary outcome measure), Mayo Elbow Performance Score (MEPS), QuickDASH, SF-12, clinical examination, and radiographic evaluation (14 and 28 in the nonoperative and ORIF groups, respectively). Elbow ROM was assessed with a goniometer and hand grip strength with calibrated strength testing. We assessed possible predictive variables (age, displacement, energy of injury) for clinical outcome scores and recorded complications. RESULTS PREE scores were not different between groups, but the MEPS favored the nonoperative group (93 versus 86; p = 0.012). ROM and grip strength were similar between groups. Younger age was associated with worse outcome, but displacement and energy were not. More complications occurred in the ORIF group (eight cases of mild heterotopic ossification, two cases of hardware failure) than in the nonoperative group (one case of mild heterotopic ossification, one case of complex regional pain syndrome). CONCLUSIONS No clinical benefit with ORIF could be found compared to nonoperative management of isolated partial articular radial head fractures with displacement of greater than 2 mm but less than 5 mm at short-term followup. A well-designed randomized trial and followup at longer term are required to provide better information about how to treat these common fractures. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Albert Yoon
- />Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Graham J. W. King
- />Roth/McFarlane Hand and Upper Limb Centre, St Joseph’s Health Care London, 268 Grosvenor Street, London, ON N6A4L6 Canada
| | - Ruby Grewal
- />Roth/McFarlane Hand and Upper Limb Centre, St Joseph’s Health Care London, 268 Grosvenor Street, London, ON N6A4L6 Canada
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Bruinsma W, Kodde I, de Muinck Keizer RJO, Kloen P, Lindenhovius ALC, Vroemen JPAM, Haverlag R, van den Bekerom MPJ, Bolhuis HW, Bullens PHJ, Meylaerts SAG, van der Zwaal P, Steller PE, Hageman M, Ring DC, den Hartog D, Hammacher ER, King GJW, Athwal GS, Faber KJ, Drosdowech D, Grewal R, Goslings JC, Schep NWL, Eygendaal D. A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial. BMC Musculoskelet Disord 2014; 15:147. [PMID: 24885637 PMCID: PMC4109703 DOI: 10.1186/1471-2474-15-147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/30/2014] [Indexed: 12/11/2022] Open
Abstract
Background The choice between operative or nonoperative treatment is questioned for
partial articular fractures of the radial head that have at least 2
millimeters of articular step-off on at least one radiograph (defined as
displaced), but less than 2 millimeter of gap between the fragments (defined
as stable) and that are not associated with an elbow dislocation,
interosseous ligament injury, or other fractures. These kinds of fractures
are often classified as Mason type-2 fractures. Retrospective comparative
studies suggest that operative treatment might be better than nonoperative
treatment, but the long-term results of nonoperative treatment are very
good. Most experts agree that problems like reduced range of motion, painful
crepitation, nonunion or bony ankylosis are infrequent with both
nonoperative and operative treatment of an isolated displaced partial
articular fracture of the radial head, but determining which patients will
have problems is difficult. A prospective, randomized comparison would help
minimize bias and determine the balance between operative and nonoperative
risks and benefits. Methods/Design The RAMBO trial (Radial Head – Amsterdam – Amphia – Boston
- Others) is an international prospective, randomized, multicenter trial.
The primary objective of this study is to compare patient related outcome
defined by the ‘Disabilities of Arm, Shoulder and Hand (DASH)
score’ twelve months after injury between operative and nonoperative
treated patients. Adult patients with partial articular fractures of the
radial head that comprise at least 1/3rd of the articular
surface, have ≥ 2 millimeters of articular step-off but
less than 2 millimeter of gap between the fragments will be enrolled.
Secondary outcome measures will be the Mayo Elbow Performance Index (MEPI),
the Oxford Elbow Score (OES), pain intensity through the ‘Numeric
Rating Scale’, range of motion (flexion arc and rotational arc),
radiographic appearance of the fracture (heterotopic ossification,
radiocapitellar and ulnohumeral arthrosis, fracture healing, and signs of
implant loosening or breakage) and adverse events (infection, nerve injury,
secondary interventions) after one year. Discussion The successful completion of this trial will provide evidence on the best
treatment for stable, displaced, partial articular fractures of the radial
head. Trial registration The trial is registered at the Dutch Trial Register: NTR3413.
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Affiliation(s)
- Wendy Bruinsma
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.
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Jayaram PR, Bhattacharyya R, Jenkins PJ, Anthony I, Rymaszewski LA. A new "virtual" patient pathway for the management of radial head and neck fractures. J Shoulder Elbow Surg 2014; 23:297-301. [PMID: 24524978 DOI: 10.1016/j.jse.2013.11.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/31/2013] [Accepted: 11/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally displaced radial head and neck fractures are common and the outcome with conservative treatment is generally excellent. A new protocol was introduced to manage patients with these suspected fractures at a major urban hospital. Simple, undisplaced fractures without other associated injuries or instability were discharged with structured advice but no further face-to-face review. Patients with more complex injuries were reviewed at a "virtual clinic." The aim of this study was to examine the outcome of this process in terms of patient flow, satisfaction, reattendance, and reintervention. METHODS The 202 eligible patients, who presented during a 1-year period from October 2011 to October 2012, were identified retrospectively from a prospectively collected administrative database. Mason type III and IV fractures were excluded. A questionnaire was administered by mail or phone call to assess satisfaction with the process, information received, and function. RESULTS Twenty (10%) patients required face-to-face review in a clinic, whereas 182 (90%) were managed with direct discharge; 155 patients responded to the survey (77%). The overall satisfaction rate was 96% in the suspected fracture group and 87% in the definite fracture group (P = .08). Satisfaction with the information provided was 95%. Two (1%) required late surgical intervention. CONCLUSION In this study, patients with suspected Mason I or II fractures were managed with limited face-to-face follow-up with high satisfaction rates. The reintervention rate was extremely low. This process has significant benefits to patients, who have fewer hospital visits, and to orthopaedic departments, which have more time to devote to complex cases.
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Affiliation(s)
- Prem R Jayaram
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
| | - Rahul Bhattacharyya
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Paul J Jenkins
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Iain Anthony
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Lech A Rymaszewski
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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Li N, Chen S. Open reduction and internal-fixation versus radial head replacement in treatment of Mason type III radial head fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:851-5. [DOI: 10.1007/s00590-013-1367-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/08/2013] [Indexed: 10/26/2022]
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Elbow dislocations: a review ranging from soft tissue injuries to complex elbow fracture dislocations. Adv Orthop 2013; 2013:951397. [PMID: 24228180 PMCID: PMC3818812 DOI: 10.1155/2013/951397] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/21/2013] [Indexed: 01/17/2023] Open
Abstract
This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness.
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Clinical reasoning and advanced practice privileges enable physical therapist point-of-care decisions in the military health care system: 3 clinical cases. Phys Ther 2013; 93:1234-43. [PMID: 23392183 DOI: 10.2522/ptj.20120148] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Physical therapists frequently make important point-of-care decisions for musculoskeletal injuries and conditions. In the Military Health System (MHS), these decisions may occur while therapists are deployed in support of combat troops, as well as in a more traditional hospital setting. Proficiency with the musculoskeletal examination, including a fundamental understanding of the diagnostic role of musculoskeletal imaging, is an important competency for physical therapists. The purpose of this article is to present 3 cases managed by physical therapists in unique MHS settings, highlighting relevant challenges and clinical decision making. CASE DESCRIPTION Three cases are presented involving conditions where the physical therapist was significantly involved in the diagnosis and clinical management plan. The physical therapist's clinical privileges, including the ability to order appropriate musculoskeletal imaging procedures, were helpful in making clinical decisions that facilitate timely management. The cases involve patients with an ankle sprain and Maisonneuve fracture, a radial head fracture, and a pelvic neoplasm referred through medical channels as knee pain. OUTCOMES Clinical pathways from point of care are discussed, as well as the reasoning that led to decisions affecting definitive care for each of these patients. In each case, emergent treatment and important combat evacuation decisions were based on a combination of examination and management decisions. DISCUSSION Physical therapists can provide important contributions to the primary management of patients with musculoskeletal conditions in a variety of settings within the MHS. In the cases described, advanced clinical privileges contributed to the success in this role.
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Fowler JR, Goitz RJ. Radial head fractures: indications and outcomes for radial head arthroplasty. Orthop Clin North Am 2013; 44:425-31, x. [PMID: 23827844 DOI: 10.1016/j.ocl.2013.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Radial head fractures without associated bony or ligamentous injury can be safely treated with internal fixation, if possible, or arthroplasty if nonreconstructable. However, nonreconstructable radial head fractures in association with elbow dislocation and/or ligamentous injury in the elbow or forearm represent a specific subset of injuries that requires restoration of the radiocapitellar articulation for optimal function. The purpose of this article was to summarize the indications for radial head arthroplasty and discuss the reported outcomes.
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Affiliation(s)
- John R Fowler
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Abstract
Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or forearm or ligament injury, where stiffness following non-operative management is the primary concern. Displaced unstable fractures of the radial head are usually associated with other fractures or ligament injuries, and restoration of radiocapitellar contact by reconstruction or prosthetic replacement of the fractured head is necessary to prevent subluxation or dislocation of the elbow and forearm. In fractures with three or fewer fragments (two articular fragments and the neck) and little or no metaphyseal comminution, open reduction and internal fixation may give good results. However, fragmented unstable fractures of the radial head are prone to early failure of fixation and nonunion when fixed. Excision of the radial head is associated with good long-term results, but in patients with instability of the elbow or forearm, prosthetic replacement is preferred. This review considers the characteristics of stable and unstable fractures of the radial head, as well as discussing the debatable aspects of management, in light of the current best evidence.
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Affiliation(s)
- A D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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