R Nietschke, K J Burkhart, B Hollinger, F I Dehlinger, A Zimmerer, M M Schneider
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In 38 cases, radial head fractures were initially treated with immobilization for 3.4 weeks (range, 1-8 weeks). Physiotherapeutic treatment was performed in 39 cases. In only half of the cases was retrospective Mason classification possible: 20 type I, 8 type II, 5 type III, and 2 type IV. Of the 70 patients, 53 had posttraumatic elbow stiffness; 34 had isolated lateral and four patients isolated medial ligament instability. There were eight cases with a combination of lateral and medial ligament instability and 27 cases of elbow stiffness combined with instability. An average of 1.2 (range, 1-4) surgical procedures per patient were performed. In all, 64 patients underwent elbow arthroscopy with arthrolysis and additional treatment depending on other injuries. The range of motion improved on average from preoperative flexion/extension of 131-15-0° to postoperative flexion/extension of 135-5-0° (gain in flexion: 4.2° and extension: 10.6°).</p><p><strong>Conclusion: </strong>Conservative treatment of radial head fractures does not always yield good results. Reasons for a poor outcome include chronic instability, cartilage damage, stiffness, or a combination thereof. Improved outcomes can be achieved via arthroscopic arthrolysis.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"13 2","pages":"112-120"},"PeriodicalIF":0.5000,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-018-0456-2","citationCount":"5","resultStr":"{\"title\":\"Reasons for surgical revision after conservatively treated radial head fractures-retrospective study of 70 patients.\",\"authors\":\"R Nietschke, K J Burkhart, B Hollinger, F I Dehlinger, A Zimmerer, M M Schneider\",\"doi\":\"10.1007/s11678-018-0456-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>An inadequate clinical outcome after conservatively treated radial head fractures is not uncommon. We analyzed the subjective limitations, objective complaints, and surgical procedures for radial head fractures initially treated conservatively.</p><p><strong>Patients and method: </strong>Between 2007 and 2016, 70 patients (42 men, 28 women) who suffered from fracture sequelae after conservatively treated radial head fractures were examined. Demographic (age, 41.8 years, range, 16-75 years) and clinical data (pain, range of motion, instability) were retrospectively evaluated.</p><p><strong>Results: </strong>The average time to surgery after trauma was 50 months (range, 5-360 months). In 38 cases, radial head fractures were initially treated with immobilization for 3.4 weeks (range, 1-8 weeks). Physiotherapeutic treatment was performed in 39 cases. In only half of the cases was retrospective Mason classification possible: 20 type I, 8 type II, 5 type III, and 2 type IV. Of the 70 patients, 53 had posttraumatic elbow stiffness; 34 had isolated lateral and four patients isolated medial ligament instability. There were eight cases with a combination of lateral and medial ligament instability and 27 cases of elbow stiffness combined with instability. An average of 1.2 (range, 1-4) surgical procedures per patient were performed. In all, 64 patients underwent elbow arthroscopy with arthrolysis and additional treatment depending on other injuries. The range of motion improved on average from preoperative flexion/extension of 131-15-0° to postoperative flexion/extension of 135-5-0° (gain in flexion: 4.2° and extension: 10.6°).</p><p><strong>Conclusion: </strong>Conservative treatment of radial head fractures does not always yield good results. Reasons for a poor outcome include chronic instability, cartilage damage, stiffness, or a combination thereof. 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Reasons for surgical revision after conservatively treated radial head fractures-retrospective study of 70 patients.
Background: An inadequate clinical outcome after conservatively treated radial head fractures is not uncommon. We analyzed the subjective limitations, objective complaints, and surgical procedures for radial head fractures initially treated conservatively.
Patients and method: Between 2007 and 2016, 70 patients (42 men, 28 women) who suffered from fracture sequelae after conservatively treated radial head fractures were examined. Demographic (age, 41.8 years, range, 16-75 years) and clinical data (pain, range of motion, instability) were retrospectively evaluated.
Results: The average time to surgery after trauma was 50 months (range, 5-360 months). In 38 cases, radial head fractures were initially treated with immobilization for 3.4 weeks (range, 1-8 weeks). Physiotherapeutic treatment was performed in 39 cases. In only half of the cases was retrospective Mason classification possible: 20 type I, 8 type II, 5 type III, and 2 type IV. Of the 70 patients, 53 had posttraumatic elbow stiffness; 34 had isolated lateral and four patients isolated medial ligament instability. There were eight cases with a combination of lateral and medial ligament instability and 27 cases of elbow stiffness combined with instability. An average of 1.2 (range, 1-4) surgical procedures per patient were performed. In all, 64 patients underwent elbow arthroscopy with arthrolysis and additional treatment depending on other injuries. The range of motion improved on average from preoperative flexion/extension of 131-15-0° to postoperative flexion/extension of 135-5-0° (gain in flexion: 4.2° and extension: 10.6°).
Conclusion: Conservative treatment of radial head fractures does not always yield good results. Reasons for a poor outcome include chronic instability, cartilage damage, stiffness, or a combination thereof. Improved outcomes can be achieved via arthroscopic arthrolysis.
期刊介绍：
Zielsetzung der Zeitschrift
Die Zeitschrift Obere Extremität widmet sich der Versorgung von Verletzungen, Verletzungsfolgen und Erkrankungen im Bereich des Schulter- und des Ellenbogengelenks.
Frei eingereichte Originalien präsentieren Forschungsergebnisse aktueller Studien im Bereich der Schulter- und Ellenbogenchirurgie und fördern den wissenschaftlichen Austausch. Vielversprechende Studien, die derzeit durchgeführt werden, sind ebenso willkommen, wie Langzeitstudien, die bewährte Verfahren auf den Prüfstand stellen. Fallberichte beleuchten seltene Indikationen und schildern ungewöhnliche Behandlungsverläufe.
Umfassende Übersichtsarbeiten zu einem aktuellen Schwerpunktthema sind das Kernstück jeder Ausgabe. Im Mittelpunkt steht gesichertes Wissen mit hoher Relevanz für die tägliche Arbeit in der Schulter- und Ellenbogenchirurgie. Zusätzlich wird in speziellen Rubriken über innovative Behandlungsmaßnahmen, Probleme in der Begutachtung, berufspolitische Entwicklungen und Kongressaktivitäten berichtet.
Als gemeinsames Kommunikations- und Weiterbildungsforum für alle Chirurg*innen und Orthopäd*innen mit entsprechender Spezialisierung ist die Zeitschrift Obere Extremität zukunftsorientiert und schließt eine wichtige Lücke im orthopädisch-unfallchirurgischen Informationsangebot.
Aims & scope
The journal Obere Extremität (Upper Extremity) is dedicated to the treatment of injuries, consequences of injuries and diseases in the area of the shoulder and elbow joint.
Freely submitted originals present research results of current studies in the field of shoulder and elbow surgery and promote scientific exchange. Promising studies that are currently being carried out are welcome, as are long-term studies that put proven procedures to the test. Case reports illuminate rare indications and describe unusual courses of treatment.
Comprehensive reviews on a current focus topic are the core of each issue. The focus is on secured knowledge with high relevance for the daily work in shoulder and elbow surgery. In addition, special sections report on innovative treatment measures, problems in assessment, professional policy developments and congress activities.
As a joint communication and further education forum for all surgeons and orthopaedic surgeons with appropriate specialisation, the journal Obere Extremität is future-oriented and closes an important gap in the orthopaedic trauma surgery information offer.
Begutachtung / Peer Review
Alle Beiträge, die bei der Zeitschrift Obere Extremität eingereicht werden (einschließlich der eingeladenen Manuskripte) durchlaufen ein Doppelblind-Peer-Review-Verfahren, an dem mindestens zwei unabhängige Experten beteiligt sind.---
All manuscripts submitted to the journal Obere Extremität (including invited manuscripts) undergo a double-blind peer review process involving at least two independent experts.
Ethische Richtlinien / Best Practice Guidelines and Publication Ethics
Die Zeitschrift Obere Extremität folgt den Richtlinien des Komitees für Publikationsethik (COPE). Autoren wird empfohlen, klinische Studien, die sie zur Veröffentlichung in Betracht ziehen, vor der Veröffentlichung in kostenlosen, öffentlichen Registern für klinische Studien (z.B. www.clinicaltrials.gov, http://clinicaltrials.ifpma.org, http://isrctn.org, www.germanctr.de/online-Register_de.html) zu registrieren. Die Register sind nach den Richtlinien des International Committee of Medical Journal Editors (ICMJE) zu genehmigen. Die Autor*innen sollten am Ende ihres Abstracts den Namen des Studienregisters und ihre Registriernummer für klinische Studien angeben.
The journal Obere Extremität (Upper Extremity) follows the Committee of Publications Ethics (COPE) - Guidelines. Authors are recommended to register clinical trials they consider for publication in free, public clinical trial registries (e.g., www.clinicaltrials.gov, http://clinicaltrials.ifpma.org, http://isrctn.org, www.germanctr.de/online-Register_de.html) before publication. The registries are to be approved by the guidelines of the International Committee of Medical Journal Editors (ICMJE). Authors should include the name of the trial register and their clinical trial registration number at the end of their abstract.
Deklaration von Helsinki / Declaration of Helsinki
Alle zur Veröffentlichung eingereichten Manuskripte, die Ergebnisse von Studien an Proband*innen oder Patient*innen präsentieren, müssen gemäß den Autorenrichtlinien für Originalarbeiten der Deklaration von Helsinki entsprechen.
All Manuscripts submitted for publication presenting results from studies on probands or patients must comply with the Declaration of Helsinki according to the author guidelines for original papers.
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