[Radial Head Replacement: Management of Elbow and Forearm Instability after Comminuted Radial Head Fractures Associated with Elbow Dislocation].

IF 0.4 4区 医学 Q4 ORTHOPEDICS
M Streck, M Vlček, D Veigl, J Pech, I Landor
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引用次数: 0

Abstract

Purpose of the study: This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement.

Material and methods: The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher's surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated.

Results: In the EXT group, the mean elbow flexion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow flexion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients.

Conclusions: Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection.

Key words: radial head, elbow, fracture, dislocation, resection, prosthesis.

[桡骨头置换术:桡骨头粉碎性骨折伴肘关节脱位后的肘关节和前臂不稳定性治疗]。
研究目的本手稿旨在确定与肘关节脱位相关的桡骨头骨折手术治疗的适应症算法。研究比较了桡骨头多段骨折切除术与桡骨头置换术患者的中期功能预后:34名平均年龄为42.5岁(年龄范围为20-81岁)的桡骨头骨折患者按手术类型分为两组。EXT组包括20名接受桡骨头切除术治疗的桡骨头骨折患者。END组包括14名接受桡骨头置换术的患者。所有患者的桡骨头骨折均伴有肘关节脱位(根据Mason-Johnston分类法,为IV型骨折)。两组所有患者均采用改良的 Kocher 手术方法。在EXT组,进行了桡骨头碎片切除术。END组采用ExploR®模块化桡骨头系统(Zimmer, Biomet, USA),该系统由钴铬合金头和钛干组成。门诊康复治疗结束后(平均随访时间为 2.4 年),对肘关节和前臂的疼痛和活动范围进行了评估。同时,还对肘关节的稳定性进行了评估。拍摄X光片以检测异位骨化、桡骨近端化以及假体松动的迹象。对再次手术的频率进行了跟踪。计算梅奥肘关节功能评分(MEPS):在EXT组中,平均肘关节屈曲度为117.5°,平均肘关节前伸/上举度为166.9°。50%的患者获得的MEPS大于90分,这意味着其功能结果极佳。1名患者(5%)发生了复发性肘关节脱位,因此需要进行翻修手术(使用Kirschner钢丝进行肘关节固定,并缝合内侧副韧带)。还有 2 名患者(10%)的桡骨头碎片没有全部取出,因此进行了翻修手术。此外,还观察到肘关节不稳定(2 名患者)和暂时性桡神经麻痹(1 名患者)。1例患者出现桡骨离散性近端化。END组患者的平均肘关节屈曲度为112°,平均肘关节前伸/上举度为135°。69%的患者的MEPS大于90分,这意味着疗效极佳。有 3 名患者(21%)在负重时出现疼痛。有 5 名患者(35%)的 X 光片显示假体柄周围有放射性透明区。所有患者均未进行翻修手术或假体移除手术。没有不稳定、神经系统并发症或感染的报告。在EXT组和END组中,有4名患者发生了异位骨化:结论:在治疗伴有肘关节脱位的多段骨折时,桡骨头置换术与桡骨头切除术相比,可增加肘关节和前臂的稳定性。与桡骨头切除术相比,植入桡骨头假体的患者组获得良好功能结果的比例更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.70
自引率
25.00%
发文量
53
期刊介绍: Editorial Board accepts for publication articles, reports from congresses, fellowships, book reviews, reports concerning activities of orthopaedic and other relating specialised societies, reports on anniversaries of outstanding personalities in orthopaedics and announcements of congresses and symposia being prepared. Articles include original papers, case reports and current concepts reviews and recently also instructional lectures.
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