Outcome of Radial Head Arthroplasty in Comminuted Radial Head Fractures: Short and Midterm Results

Background: Comminuted radial head fractures are often associated with secondary injuries and elbow instability. Objectives: The aim of this retrospective study was to evaluate how well the modular metallic radial head implant EVOLVE® prosthesis restores functional range of motion (ROM) and stability of the elbow in acute care. Patients and Methods: Eighty-five patients with comminuted radial head fractures and associated injuries received treatment with an EVOLVE® prosthesis between May ۲۰۰۱ and November ۲۰۰۹. Seventy-five patients were available for follow-up. On average, patients were followed for ۴۱.۵ months (۳۳.۰: ۴.۰ - ۹۳.۰). Outcome assessment was done on the basis of pain, ROM, strength, radiographic findings, and functional rating scores such as Broberg and Morrey, the Mayo elbow performance index (MEPI), and disabilities of the arm, shoulder and hand (DASH). Our study is currently the largest analysis of clinical outcome of a modular radial head replacement in the literature. Results: Overall, there were ۲ (۲.۷%) Mason II fractures, ۲۱ (۲۸%) Mason III fractures, and ۵۲ (۶۹.۳%) Mason IV fractures. Arbeitsgemeinschaft fur osteosynthesefragen (AO) classification was also determined. Of the ۸۵ patients in our study, ۷۵ were available for follow-up. Follow-up averaged ۴۱.۵ months (range, ۴ - ۹۳ months). Average scores for the cohort were as follows: Morrey, ۸۵.۷ (median ۹۰.۲; range ۴۴.۴ - ۱۰۰); MEPI, ۸۳.۳ (۸۵.۰; ۴۰.۰ - ۱۰۰); and DASH ۲۶.۱ points (۲۲.۵; ۰.۰ - ۷۵.۸). Mean flexion/extension in the affected joint was ۱۲۵.۷°/۱۶.۵°/۰° in comparison to the noninjured side ۱۳۸.۵°/۰°/۱.۲°. Mean pronation/supination was ۷۰.۵°/۰°/۶۷.۱° in comparison to the noninjured side ۸۳.۶°/۰°/۸۴.۳°. Handgrip strength of the injured compared to the non-injured arm was ۷۸.۸%. The following complications were also documented: ۵۸ patients had periprosthetic radioluceny shown to be neither clinically significant nor relevant according to evaluated scores; ۲۶ patients had moderate or severe periarticular ossification, and scored substantially worse according to MEPI and Morrey. Four patients required revisional surgery due to loosening of the prosthesis and chronic pain. In addition, one patient required a neurolysis of the ulnaris nerve, one developed a neobursa, and one had extensive swelling and blistering. The time interval between injury and treatment appeared to have an effect on results. Thirty-five patients were treated within the first ۵ days after accident and showed better results than the ۴۰ patients who were treated after ۵ days. Conclusions: Comminuted radial head fractures with elbow instability can be treated well with a modular radial head prosthesis, which restores stability in acute treatment. The modular radial head arthroplasty used in this study showed promising findings in short to midterm results.

کلیدواژه ها:

Radial Head ، fracture ، prosthesis ، Arthroplasty ، Elbow Instability