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.

[Mason I fracture - a simple injury?]. / Mason-I-Fraktur - eine harmlose Verletzung?

BACKGROUND: Mason I fractures of the radial head are judged to be simple injuries that can generally be treated nonoperatively. According to the current literature mainly good and excellent results can be expected. We present a case series of patients presenting to us due to complications of Mason I fractures. PATIENTS AND METHODS: We reviewed all cases of patients that were treated because of complaints following Mason I radial head fractures. In all, 16 patients (10 men and 6 women) were identified. Mean age was 37 years (range 16-59 years). Mean time between trauma and surgery was 25 months (range 1-108 months). RESULTS: Ten patients developed painful osteoarthritis with elbow stiffness and loose bodies, 4 patients suffered a posterolateral rotatory instability that had to be treated with ligament reconstruction, 1 patient presented with a combined medial and lateral instability, and 1 patient with a symptomatic hypertophic plica posterolateralis. Diagnotics and therapeutic concepts of these complications will be presented. CONCLUSION: In light of the complications, Mason I fractures must be reevaluated. They remain the domain of conservative treatment but close follow-up is recommended to recognize possible complications early in order to prevent stiffness, chronic instabilities, and osteoarthritis.

[LUCL reconstruction using a triceps tendon graft to treat posterolateral rotatory instability of the elbow]. / LUCL-Bandplastik mit Trizepssehnentransplantat zur Therapie der posterolateralen Rotationsinstabilität am Ellenbogen.

OBJECTIVE: Re-establishment of radial stability within the elbow joint in cases of arthroscopically or clinically confirmed posterolateral rotatory instability. INDICATIONS: Posttraumatic or chronic degenerative posterolateral rotatory instability at least grade I-II according to O'Driscoll. CONTRAINDICATIONS: Elbow stiffness or elbow arthritis and lateral epicondylitis, if a posterolateral rotatory instability has been excluded as the reason for the symptoms. SURGICAL TECHNIQUE: Reconstruction or augmentation of the insufficient lateral ulnar collateral ligament (LUCL) with an autologous triceps tendon graft. A stripe of the triceps tendon is fixed at the epicondylus humeri radialis and at the base of the annular ligament at the proximal radial ulna with tenodesis screws or buttons, then the extensor origins, which were detached before are fixated as well. POSTOPERATIVE MANAGEMENT: Postoperative treatment with an elbow orthesis for 6 weeks, in the first 4 weeks limitation of complete extension and flexion, full weight bearing after 3 months. RESULTS: Retrospective analysis of 47 LUCL reconstructions from 2008-2010 with good results concerning pain reduction and acceptance, improvement of the Mayo Elbow Performance Score from 49 to 82, low complication rate with one elbow stiffness, one temporary ulnar nerve lesion, and one recurrent instability.

[Transosseous refixation of the common extensor muscle tendons in chronic lateral epicondylitis with and without additional reconstruction of the LUCL--a retrospective evaluation of 101 patients]. / Die transossäre Refixation der Extensoren bei chronischer radialer Epikondylopathie mit und ohne Rekonstruktion des LUCL-Komplexes--eine retrospektive Analyse von 101 Patienten.

INTRODUCTION: The chronic lateral epicondylitis (EHR) as a common pathology of the elbow is often associated with posterolateral rotatory instability of the elbow (PLRI). After evaluation of intra-articular pathology by prior diagnostic arthroscopy, we aimed to build patient groups regarding the stability of the elbow joint. In patients with a stable elbow joint, open surgery with a debridement to the origin of the common extensor tendon and transosseous refixation was performed. Patients with relevant posterolateral rotatory instability, however, underwent an additional LUCL complex stabilisation using triceps tendon graft besides debridement as mentioned above. The purpose of this study was to evaluate and compare the clinical functional outcome between these groups. MATERIAL AND METHODS: 101 patients were included in our study. Arthroscopies were first performed on all patients to identify intra-articular pathological changes. In 26 patients with stable elbows, open surgery with debridement to the origin of the common extensor tendon and transosseous refixation was performed. For the other 75 patients who were found presenting a relevant posterolateral rotatory instability, a stabilisation of the LUCL in addition to the open procedure mentioned above was performed. Examinations and questionnaires were used for retrospective evaluation at follow-up. RESULTS: Both groups of patients revealed significant improvement in pain relief and elbow function. We observed no significant difference between the two methods concerning clinical and functional outcome. CONCLUSION: We recommend diagnostic arthroscopy with assessment of stability prior to the open performance to offer a more reliable evidence for surgical technique selection and therefore to achieve a better clinical outcome.

Therapeutic options for acute and chronic elbow instability.

INTRODUCTION: Acute elbow instability usually develops after injuries involving the bony or ligamentous stabilizers of the joint. It occurs frequently after dislocation and/or fracture-dislocation, but isolated valgus or varus overloading can also lead to ligament ruptures with subsequent instability. Chronic instability can result from incompletely healed acute injuries or from recurring microtrauma, for example after repetitive strain from participating in certain sports. CONCLUSION: Stable conditions of the joint are essential for early functional post-traumatic or postoperative treatment of the elbow, as permanent mobility deficits may result otherwise. The following article gives an overview of the current understanding of these injuries and concepts in treatment.