Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures.

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.

Comminuted radial head fractures treated by the Acumed anatomic radial head system.

OBJECTIVE: The treatment of comminuted radial head fractures is still challenging. A radial head replacement is more effective in comminuted radial head fractures. The aim of this paper was to present the medium-term results of the Acumed anatomic radial head system (AARHS). METHODS: This study was performed on 12 patients with traumatic elbow fracture and instability between 2008 and 2011 of whom 12 were reviewed at a mean follow-up of 60.8 months (19 to 77 months). The evaluation included a record of pain, function, muscle strength, contracture and rotation. The outcome was assessed using the Hospital for Special Surgery total elbow scoring and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. RESULTS: The average flexion and extension arc was 130° (range, 110° to 140°). The mean range of elbow supination was 75° (rang, 60° to 85°) and pronation 80° (range, 65° to 90°). There were no complications such as infection, implant loosening, instability of the elbow, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. The mean DASH score was 11.9/100 (0 to 25/100). CONCLUSION: The radial head replacement with the AARHS can provide effectively stability and good clinic results at the middle term following up. Our experience has encouraged us to continue using the AARHS in comminuted fractures, especially when instability of elbow is a potential problem.

Comminuted radial head fractures treated with pyrocarbon prosthetic replacement.

PURPOSE: We had evaluated our experience in the treatment of displaced and comminuted radial head fractures with pyrocarbon radial head prosthesis. METHODS: From May 2003 to July 2008, radial head prostheses were performed in 47 patients. There were 29 female and 18 male with mean age 51 (34-70 years). The follow-up was a mean of 48 (12-60 months). Fractures of the radial head have been classified by Hotchkiss. The indications for a radial head replacement were type III fractures in 27 cases, type IV fractures in ten cases, comminuted radial fracture associated with disruption of the medial collateral ligament in three cases, Monteggia variant in five cases, and Essex-Lopresti in two cases. Functional outcomes were assessed by visual analog scales (VAS) of pain, joint motion and stability, and using the Mayo Elbow Performance Index. RESULTS: The mean VAS score for elbow pain was 1 (0.5-2.1). Patients showed an average arc of motion from 6° to 140°, with 75° of pronation and 67° of supination. By using the Mayo Elbow Performance Index, 42 patients had good/excellent results, with three fair and two poor outcomes. Complications were two implant dislocations, one elbow stiffness, one dissociation of the implant, one stem rupture, and two posterior interosseous nerve palsy that recovered from 5 to 8 weeks. We had not seen persistent instability, infection, synostosis, severe degenerative changes, or impingement. CONCLUSIONS: The treatment of comminuted radial head fracture with pyrocarbon implant usually gives an optimal result depending on the severity of the initial injury and the presence of associated lesions. The size of the prosthesis is often overestimated, causing restriction in motion due to impingement, overstuffing, or dislocations.