Surgical revision of radial head fractures: a multicenter retrospective analysis of 466 cases.

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.

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability After Failed Common Extensor Origin Release: Outcomes at Minimum 2-Year Follow-up.

BACKGROUND: In patients with chronic lateral epicondylitis who have failed nonoperative treatment, open or percutaneous release of the common extensor origin (CEO) without subsequent reconstruction tends to result in good clinical outcomes. However, surgery can lead to iatrogenic injuries of the lateral collateral ligamentous complex, causing posterolateral rotatory instability (PLRI). PURPOSE: To determine the clinical outcomes of lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon graft after failed open CEO surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 103, patients underwent revision surgery at a single institution because of PLRI after failed open release of the CEO (Hohmann procedure) between January 2007 and October 2016. The primary surgery had been performed at other institutions in all cases. Of these patients, 72 were available for follow-up (49 by clinical examination, 23 by telephone interview). Standardized clinical examination; Mayo Elbow Performance Score (MEPS); 11-item version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH); subjective elbow value (SEV); and patient satisfaction were assessed at least 2 years after LUCL reconstruction. RESULTS: The mean age of patients in the study was 46.9 years (range, 21-74 years), and the mean follow-up was 2.8 years after revision surgery. The mean MEPS was 78.9, and the mean QuickDASH score reached 20.4. The mean SEV was 78.6%, and 75% of the patients rated the surgery as good to excellent. Complications were detected in 14% of the patients, and 9 needed revision surgery, primarily owing to graft failure with recurrent instability (n = 5). CONCLUSION: LUCL reconstruction in patients with PLRI after release of the CEO can restore elbow stability and achieve high patient satisfaction. However, outcome scores and revision rates in this cohort were inferior to published outcomes of primary LUCL reconstruction for treatment of noniatrogenic or traumatic PLRI.

Translation of the Mayo Elbow Performance Score (MEPS) into German (MEPS-G). / Die Übertragung des Mayo Elbow Performance Score (MEPS) ins Deutsche (MEPS-G).

BACKGROUND: The Mayo Elbow Performance Score is a clinical assessment to rate the performance of the elbow from a medical and/or therapeutic perspective. It is simple and efficient to operate and therefore frequently used in research as well as in clinics. However, an adequate translation of the MEPS into the German language and a verification of the quality criteria for the use in the German health system are currently lacking. GOAL OF THE STUDY: The aim of this study is to translate the MEPS and to review the applicability of the German version (MEPS-G) in Germany. MATERIALS AND METHODS: The translation was undertaken on the basis of a guideline for cultural adaptation. Two independent translations were created, combined and translated back into English by two native speakers. The back translations were reviewed and the German version was amended accordingly. The suitability of the final questionnaire was verified in a pretest with 73 participants. RESULTS: The MEPS was converted into the German version MEPS-G and was tested. Apart from minor adjustments, the questionnaire was translated into German without difficulty. The time to complete the assessment was on average 2.5 min (± 1.6). CONCLUSION: First analyses of the psychometric properties of the German MEPS showed identical values as the English version. The detailed quality criteria will be reviewed in a subsequent study.

Development and verification of a mathematical model to quantify the joint spaces of the elbow.

The purpose of the study was a development and verification of a model to quantify elbow joint spaces focusing on posterolateral rotatory instability. The model was tested for feasibility and applied to open and arthroscopic surgeries. A mathematical kinematic model was created, consisting of two segments representing the humerus and radius and ulna. Model calculations of the joint opening were compared with direct measurements on a mechanical model with attached marker arrays, and compared with values determined by a digital sliding caliper in order to evaluate the mathematical kinematic rigid body model of the elbow joint. Joint angles predicted by the mathematical model were compared with values determined by a two axis goniometer. The evaluation showed significant accordance (intercorrelation coefficient ≥0.8). The highest difference was 1.54° (root mean square: 0.46°) for all movement conditions. Ligament transaction at the open surgery situation affected an increase in joint opening (maximum joint opening: 10.9 mm±0.3). Distances in the ulnohumeral joint space (ligaments intact) under arthroscopic surgery situation varied between 4.0 and 6.8 mm (mean: 5.2 mm±1.0). Thus a possibility is created to achieve an objective assessment of joint space opening to provide a more complete description of the elbow kinematics using this approach.

From radial head to radiocapitellar to total elbow replacement: A case report.

INTRODUCTION: Radiocapitellar arthroplasty represents a possible treatment option for isolated osteoarthritis of the radial column. We report the first case of early failure of this procedure. PRESENTATION OF CASE: We present the case of a 41-year old male who sustained a terrible triad injury to his right elbow and subsequently underwent radial head arthroplasty. Due to overstuffing of the radial head prosthesis, capitellar erosion occurred and radiocapitellar arthroplasty was thus performed. Only one year later, conversion of the radiocapitellar replacement to total elbow arthroplasty was required as a result of progressive ulnohumeral osteoarthritis. DISCUSSION: According to the currently limited clinical data, radiocapitellar arthroplasty provides satisfactory results. However, biomechanical analysis shows that available prostheses do not sufficiently reproduce the radiocapitellar anatomy. The design of the prosthesis might thus have contributed to the rapid progression of ulnohumeral erosion following radiocapitellar arthroplasty although the poor outcome may also be attributed to the trauma itself along with the inadequate initial treatment. CONCLUSIONS: The indication for radiocapitellar arthroplasty warrants careful consideration given the results of biomechanical analysis and the early failure due to progressive ulnohumeral erosion seen in the present case.