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1.
Purpose
We had evaluated our experience in the treatment of displaced and comminuted radial head fractures with pyrocarbon radial head prosthesis. 相似文献2.
Ning Li Shaoying Chen 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2014,24(6):851-855
Purpose
The purpose of this study was to demonstrate whether open reduction and internal-fixation (ORIF) was superior to radial head replacement in treatment of Mason type III radial head fractures by comparing postoperative complication rate and satisfactory rate.Methods
Clinical trials comparing ORIF with radial head replacement for Mason type III radial head fractures were reviewed published up to September 1, 2012. Methodological quality of each included trials was assessed using the Jadad scale. The analyses were performed with Cochrane RevMan software version 5.1.Results
One prospective randomized controlled trial and one comparative study involving 67 patients with 67 cases were included in this systematic review and meta-analysis. Both the forest plots of complication rate and satisfactory rate indicated statistical differences between the two surgical techniques in treatment of Mason type III radial head fractures. The complication rate was 13.9 % in patients treated with radial head replacement and 58.1 % in patients treated with ORIF. The satisfactory rate was 91.7 % in patients treated with radial head replacement and 51.6 % in patients treated with ORIF.Conclusions
Given the available evidence, radial head replacement appeared to reach better outcomes in patients with Mason type III radial head fractures followed 5 years or less.Level of evidence
Therapeutic II. 相似文献3.
Demir B Gursu S Ozturk K Yildirim T Konya MN Er T 《Archives of orthopaedic and trauma surgery》2011,131(9):1195-1201
Background
We are reporting the results of single-stage treatment for patients with forearm deformity and radial head luxation due to hereditary multiple exostosis using distraction osteogenesis. 相似文献4.
Dilip Tanna 《Indian Journal of Orthopaedics》2013,47(3):283-287
Background:
Treatment of elbow dislocation with irreparable radial head fracture needs replacement of radial head to achieve stability of elbow. An alternate method in cases of elbow dislocation with radial head fracture can be resection of radial head with repair of medial collateral ligament. We report a retrospective analysis of cases of elbow dislocation with irreparable radial head treated by excision head of radius and repair of MCL.Materials and Methods:
Nine patients of elbow dislocation with associated irreparable fractures of the head of the radius were included in this analysis (6 F:3 M, Age: 35-47 years). Radial head excision was done through the lateral approach and MCL was sutured using no 3 Ethibond using medial approach. Above elbow plaster was given for 6 weeks and gradual mobilization was done thereafter. All patients were assessed at final followup using Mayo elbow performance score (MEPS).Results:
Mean followup was 19.55 ± 7.12 months (range 14-36 months). There was no extension deficit when compared to opposite side with mean range of flexion of 138.8° ± 6.97° (range 130 -145°). Mean pronation was 87.7° ± 4.4° (range 80-90°) and mean supination was 87.7 ± 4.62° (range 80-90°). The mean MEPS was 98.8 ± 3.33 (range 90-100). No patient had pain, sensory complaints, subluxation or redislocation. All were able to carry out their daily activities without disability.Conclusion:
Radial head excision with MCL repair is an acceptable option for treatment of patients with elbow dislocation and irreparable radial head fracture. 相似文献5.
Kyeong-Jin Han Kyung-Soo Oh Nam-Su Chung Yu Sang Lee Sangjin Youn 《International orthopaedics》2012,36(12):2501-2506
Purpose
Treatment of comminuted fractures of the radial head is controversial, and considerable effort has been made to restore optimal function of the elbows, either by surgical reconstruction or prosthetic replacement. This report presents our experiences in treatment of unreconstructable radial head or neck fractures using osteochondral autografts harvested from the base of the second metatarsal bones.Methods
Five patients with radial head and one with a radial neck fracture underwent treatment with osteochondral autografts. After excision of the unreconstructable radial head, the second metatarsal base was harvested and transplanted to the radius using the intramedullary nailing technique.Results
The reconstructed elbows were examined clinically and radiographically for a mean period of 44.8 months (range, 24–72 months). At the last follow-up, in flexion-extension, the mean elbow mobility was 130°/10°. In supination-pronation, the mean elbow mobility was 73.3°/66.7°, with a mean loss of supination of 19.2° and loss of pronation of 12.5°. Grip strength was 91%, compared with the contralateral limb. The mean Mayo Elbow Performance Score was 94.2. The mean score of AOFAS rating system to the lesser toe was 93.7 points.Conclusion
Radial head arthroplasty with an osteochondral autograft from the second metatarsal base appears to be an effective alternative for treatment of unreconstructable radial head fractures. A larger group of patients and a longer follow-up period will be required in order to ease concerns regarding the donor site; however, none of the patients who underwent this procedure showed any complications during follow-up. 相似文献6.
Malin Wijeratna Kimberley Anne Bailey Alistair Pace Graham Tytherleigh-Strong Lee Van Rensburg Matthew Kent 《International orthopaedics》2012,36(12):2507-2512
Purpose
This study describes a case series of 15 patients with radial head fractures who underwent radial head excision using an arthroscopic technique.Methods
Over a four year period, 15 patients (average age 49.6 years) who had sustained a radial head or radial neck fracture underwent an arthroscopic excision of the radial head. Four patients had an unreconstructable comminuted fracture (early group; EG) and 11 patients had pain and loss of motion with an associated non- or malunion (late group; LG).Results
The mean time to surgery following injury was three weeks (one to five) for the EG and 27 weeks (eight–58) for the LG. The average visual analogue scale (VAS) was 1.7 (zero to four), and the average Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score was 24.7 (16–44). At final follow-up, average supination was 62.0° (range 45–75°) and pronation was 63.3° (range 45–75°). There were no complications.Conclusion
This series demonstrates that arthroscopic excision of fractures of the radial head and neck is reliable, reproducible and safe, with similar results to open excision. There may also be additional benefits in the short term with regards to speed of healing and rehabilitation. 相似文献7.
Background/purpose
Radial head replacement is frequently used in treatment of radial head fractures or sequela. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications. The authors describe their case studies and results on the implantation of various radial head prostheses.Materials
Between June 2005 and June 2016, 28 radial head prostheses were implanted in the same number of patients with an average follow-up of 49 months (6–104). Indications for implantation were: Mason type III and IV radial head fractures and post-traumatic arthritis due to failure of previous treatments. Monopolar prostheses were used and were press-fit implanted via Kaplan’s lateral access and Kocher’s anconeus approach to the humeroradial joint. At the follow-up, assessments were made of the pain, according to the visual analogic scale, range of motion (ROM), stability and functionality according to the Mayo Elbow Performance Score, presence of osteolysis and mobilization during radiography tests, personal satisfaction of the patients, Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation outcomes measurements.Results
At the follow-up, we recorded an average level of pain of 1.8 in patients under acute treatments for radial head fractures and a marked reduction in the remaining cases from 6.7 to 2.1. ROM was found on average to be 107° of flexion–extension and 159° of pronosupination. Personal satisfaction was good–excellent in 23 cases. There was no case of infection; removal of the implant was necessary in three cases due to mobilization of the stem and oversized implants. In six cases, bone resorption was seen at the level of the prosthetic collar and it was in all cases asymptomatic.Conclusions
The results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life.8.
Laurens Kaas Jeroen L Turkenburg Roger P van Riet Jos P A M Vroemen Denise Eygendaal 《Acta orthopaedica》2010,81(3):373-376
Background and purpose
Radial head fractures are common, and may be associated with other injuries of clinical importance. We present the results of a standard additional MRI scan for patients with a radial head fracture.Patients and methods
44 patients (mean age 47 years) with 46 radial head fractures underwent MRI. 17 elbows had a Mason type-I fracture, 23 a Mason type-II fracture, and 6 elbows had a Mason type-III fracture.Results
Associated injuries were found in 35 elbows: 28 elbows had a lateral collateral ligament lesion, 18 had capitellar injury, 1 had a coronoid fracture, and 1 elbow had medial collateral ligament injury.Interpretation
The incidence of associated injuries with radial head fractures found with MRI was high. The clinical relevance should be investigated. 相似文献9.
Dragos Popescu Pedro Alvarez Gilbert Steinbacher Ramon Cugat 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2007,17(4):367-371
Introduction
We present a case of bilateral osteochondrosis of the radial head with a 9-year follow-up. The appearance of the disease in one elbow was related with a trauma-injury; meanwhile the opposite elbow had no relation with it. On the other hand, the traumatic elbow associates a chondral lesion. As far as we know, it is the first case where an osteochondral lesion is associated with this entity.Case report
Our patient is an 11-year-old male, who struck his right elbow in April 1996 and developed an osteochondrosis of the radial head. In February 1997, an arthroscopy was performed and it was found that a chondral lesion was also associated. Two years later, the child developed the disease in the opposite elbow with no traumatic incident preceding the symptoms. Nine years after, the patient was asymptomatic except for a limitation to the forearm supination of 45°. We proposed a radial head resection but the patient refused it for the moment.Discussion
The long follow-up of patient allows a good revision of the symptoms and radiological details of the disease. There is a general belief that most of the children with this disease respond well to non-operative treatment. But when symptoms are intense, loose bodies are present or the MRI suggests the association of an important chondral lesion we think an arthroscopy should be performed. Despite the remodelling that generally occurs many of the patients present a limitation in their elbow mobility that, in advanced cases, might need a radial head resection. 相似文献10.
Hao Sun Jun Duan Fengsheng Li 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(3):283-291
Purpose
Open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) are the most common operative treatments in patients with radial head fractures. The purpose of this study was to determine the efficacy of RHA and ORIF treatments in patients with radial head fractures (modified Mason type III and IV).Methods
We conducted a computerized search of five electronic databases from their inception to July 2015. All clinical trials comparing ORIF versus RHA treatment in patients with radial head fractures were included. We evaluated the primary outcomes included elbow functional evaluation criteria by Broberg and Morrey, elbow score (Broberg and Morrey), Mayo Elbow Performance Score (MEPS) and QuickDASH score. Secondary outcomes included Visual Analog Scale (VAS), range of motion, operation time and complications. The “assessing risk of bias” table was applied to assess the risk of bias of the included studies.Result
Eight studies were included in this meta-analysis, which consisted of 138 cases of ORIF and 181 RHA. Methodological quality of the studies was moderate to low. RHA afforded significantly higher satisfaction rate, better elbow score (Broberg and Morrey) and MEPS, shorter operation time, lower incidence of bone nonunion or absorption and internal fixation failure when compared to ORIF. There were no significantly differences in QuickDASH score and other complications.Conclusions
RHA has better outcome in patients with radial head fractures (modified Mason type III and IV) than ORIF with medium-short-term follow-up period, but longer-term studies will be required to ascertain whether the apparent benefits of RHA were offset by late complications.Level of evidence
Therapeutic decision analysis; a meta-analysis, Level III.11.
Background
The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of “overstuffing,” cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial. 相似文献12.
Giacomo Strigini Michele Rendina Matteo Ghiara Fabrizio Quattrini Laura Ghidoni Valeria Burgio Pietro Maniscalco Francesco Benazzo 《Injury》2019,50(2):382-385
Introduction
In this retrospective study we have analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with bone resection or prosthesis.Patients and methods
This study includes 24 patients affected by fractures mentioned above and treated between July 2009 and November 2015.15 patients (average age 48 y.o.) have been treated with prosthesis. The remaining 9 (average age 573) have been treated with a capitellectomy instead.From a clinical point of view, we have evaluated the patients according to main performance indicators such as range of motion, pain, instability and Mayo Elbow Performance Score as parameters.Results
We have found similar results in both group, with an average MEPS value of 95 in the prosthesis group and 966 in the radial head resection group.The range of motion was similar too: between 1,3° and 1203° in the first group and between 4,4° and 120° in the second one. No significant complication has detected in any patient.Discussion
According to most recent literature, it is not precisely defined how to treat isolated Mason III fractures, contrary to what is defined in more complex pattern, in which prosthesis are now evaluated as the best indication.Due to radial head limited contribution to elbow stability, in absence of other bony or ligamentous lesions both capitellectomy and prosthesis can be good treatment in this kind of fracture.Conclusion
According to our experience and to the most recent literature, we recommend prosthesis in patient younger than 50 y.o., high demanding or manual worker, while in other cases we think that radial head resection can be the treatment of choice. 相似文献13.
Purpose
This case report presents a new and unique surgical greater trochanter split procedure for reconstructing a hip joint after an infantile hip sepsis with consequent aplasia of the femoral head. 相似文献14.
F. Javier Ricón Francisco Lajara Alfonso Fuentes María Luz Aguilar Alberto Boix Juan A. Lozano 《Journal of orthopaedics and traumatology》2018,19(1):13
Background
The aim of this study is to describe the mid-term radiological findings appearing in patients with a pyrocarbon radial head prosthesis, and to correlate them to patient symptoms.Materials and methods
We review 18 patients who underwent radial head implantation of the MoPyC prosthesis between 2004 and 2015, due to unreconstructible radial head fractures. The clinical outcomes were assessed with Mayo Elbow Performance Score (MEPS). Range of motion, pain, and elbow radiological assessments were recorded. A non-parametric, statistical analysis was carried out to assess the radiological findings with the clinical outcomes.Results
We have found that after a mean follow-up of 6.5 years (2–11 years), patients have recovered a median flexion arch of 113°, therefore 77% are classed as satisfactory outcomes and the average MEPS score is 89.5. The presence of periprosthetic changes on X-ray is highly frequent—we found radiolucent lines in 38% of cases, radial neck re-absorption in 83%, and arthrosic changes in 78%. However, the differences found when correlating these changes with the clinical results have not been statistically significant (p?>?0.05).Conclusions
Satisfactory outcomes can be expected midterm when using pyrocarbon prostheses in around 75% of the cases. We consider radial neck re-absorption to be a sign of good stem osteointegration, whereas progressive radiolucencies and loss of the ballooning of the stem legs are signs of bad prognosis in our series.Level of Evidence
IV retrospective case series.15.
Dave Shukla James Fitzsimmons Kai-Nan An Shawn O’Driscoll 《International orthopaedics》2014,38(1):89-93
Purpose
Press-fit cementless radial head implant longevity relies on adequate bone ingrowth. Failed implant osseointegration remains a clinical concern and has been shown to lead to prosthetic failure. The purpose of this study was to test the hypothesis that implants with sufficient initial press-fit stability would be less likely to fail due to implant pull-out, as demonstrated by an increasing amount of energy required to remove the prosthesis from the canal.Methods
Ten cadaveric radii were implanted with five sizes (6–10 mm in 1-mm increments) of grit-blasted, cementless radial head stems. A customised slap hammer was used to measure the energy required to remove each stem. Stem-bone micromotion was also measured.Results
The suboptimally sized stem (Max − 1) (i.e. 1 mm undersized) required less energy (0.5 ± 0 J) to pull out than the optimally sized stem (Max) (1.7 ± 0.3 J) (p = 0.008). The optimally sized stem demonstrated greater initial stability (45 ± 7 μm) than the suboptimally sized stem (79 ± 12 μm) (p = 0.004).Conclusions
This investigation demonstrates the importance of obtaining adequate press-fit stability for the prevention of radial head stem pull-out failure. These data add to the relatively scant knowledge in the literature regarding radial head biomechanics. The energy required to remove a prosthetic radial head ingrowth stem decreases in conjunction with diameter. The use of an inadequately sized stem increases the stem’s micromotion as well as the risk of prosthetic loosening due to pull-out. 相似文献16.
Matthias Winter C. Pelegri T. Balaguer A. Nebunescu F. de Peretti 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2008,18(2):101-105
Objectives
Radial head replacement by using a bipolar prosthesis is frequently used when unable to reconstruct fractures of the radial head. The GUEPAR© implant is a metallic bipolar prosthesis. The authors describe an uneventful complication of this implant. Four patients have sustained an acute disassembling of the GUEPAR© implant after an important grip effort. A biomechanical study was performed in order to explain this disassembling.Method
The retention system of the GUEPAR implant has been tested at different temperatures: 4, 20 and 37°C. The stem and the cup were cemented in a support. Disassembling was achieved using a dynamometer.Results
The study has shown that the theoretical grip strength leading to disassembling is 145.65 kg at 4°C and 51.45 kg at 37°C.Discussion
The polyethylene of the floating head of the implant appears to be very influenced by the temperature. The authors state that the association of a cam effect between the floating cup and the stem with an important grip might lead to the disassembling of the GUEPAR prosthesis. This study shows that the conception of a bipolar implant is very demanding in terms of retention of the floating head on the stem. 相似文献17.
Kunihiro Oka Tsuyoshi Murase Hisao Moritomo Kazuomi Sugamoto Hideki Yoshikawa 《Clinical orthopaedics and related research》2010,468(9):2410-2418
Background
Treatment of chronic radial head dislocation is controversial, considering whether to reduce and reconstruct the proximal radioulnar joint. The anatomic alteration that influences the decision to reduce the dislocation is not completely understood. 相似文献18.
Jun-Gyu Moon MD PhD Jin-Ho Hong MD Nitin Bither MD Won-Yong Shon MD PhD 《Clinical orthopaedics and related research》2014,472(2):727-731
Background
Overstuffing of the radiocapitellar joint during metallic radial head arthroplasty has been reported to cause loss of elbow flexion, capitellar erosion, and early-onset osteoarthritis. Although this is known, there is no agreed-on measurement approach to determine whether overstuffing has occurred.Questions/purposes
We therefore hypothesized that overlengthening the radial head during radial head arthroplasty changes the ulnar variance in the wrist.Methods
Seven cadaveric radii were implanted with radial head prostheses of increasing thickness. Each specimen was implanted successively with increasingly thick radial head prostheses measuring 2, 4, and 6 mm thicker than the native radial head, and radiographs were taken after implantation of each prosthesis. The ulnar variance with each prosthesis was measured using the method of perpendiculars.Results
The ulnar variance of the native and 2-mm (p = 0.04), 4-mm (p = 0.008), and 6-mm (p = 0.008) overly thick radial head prosthesis-implanted states decreased significantly with each incremental increase in prosthetic head thickness.Conclusions
Implantation of thicker radial head prostheses decreased the ulnar variance. Our results indicate ulnar variance could be used to detect overstuffing of radial head prostheses.Clinical Relevance
The simplicity and reliability of ulnar variance make it a potentially useful indicator of overlengthening after radial head arthroplasty. 相似文献19.
Marc Schnetzke Sara Aytac Moritz Deuss Stefan Studier-Fischer Benedict Swartman Matthias Muenzberg Paul-Alfred Gruetzner Thorsten Guehring 《International orthopaedics》2014,38(11):2295-2301
Purpose
Elbow dislocations with complex elbow instability (CEI) and unstable radial head fractures require reconstruction by open reduction and internal fixation (ORIF) if possible or alternatively by a radial head prosthesis. The aim of this study was to determine the differential outcome of both strategies and to investigate the contribution of prosthesis-related radiographic factors such as oversizing on clinical outcome.Methods
A total of 53 patients underwent ligament and coronoid refixation, and radial head reconstruction by ORIF (n?=?18; group 1) or by monopolar modular prosthesis (n?=?35; group 2). Patients were followed by the Mayo Elbow Performance Score (MEPS) and a radiological score including prosthesis oversizing, joint subluxation, ossifications, capitellar erosions, implant loosening and ulno-humeral osteoarthritis. To investigate the effect of oversizing, group 2 was subdivided by prosthesis overlenghtening?≥?2 mm.Results
A total of 42 patients (79.2 %) could be followed for 3.0?±?1.3 years with an average MEPS of 76.8?±?17.2. Patients with ORIF had slightly better MEPS (82.1?±?9.9) as compared with group 2 (74.7?±?19.1) though three ORIF patients required an early conversion to prosthesis. In group 2, oversizing occurred frequently and 50 % showed an overlenghtening?≥?2 mm. Oversizing significantly decreased MEPS (63.2?±?21.3 vs 84.7?±?9.0; p?=?0.001) and elbow range of motion and increased the occurrence of other radiological abnormalities and the risk for surgical revisions. The radiological score and prosthesis overlenghtening but not prosthesis diameter showed an inverse correlation with MEPS.Conclusions
In CEI a radial head reconstruction with a prosthesis demonstrates similarly good clinical results as compared to ORIF in anatomically sized prosthesis, but prosthesis oversizing could induce other radiographic abnormalities with then deteriorated outcome. 相似文献20.