Radial Head Fractures

Clinical and functional outcomes of plate and screw osteosynthesis in mason type III and IV radial head fractures in the absence of a radial head prosthesis

INTRODUCTION

Radial head and neck fractures represent a significant portion of elbow fractures in adults, particularly affecting younger patients due to falls onto outstretched hands. Surgical treatment is often necessary for displaced and comminuted fractures, especially those with associated ligamentous injuries. This study evaluates the long-term clinical, functional, and radiological outcomes of patients with Mason type III and IV radial head fractures managed through open reduction and internal fixation using plate and screw osteosynthesis, due to the unavailability of radial head prostheses.

MATERIAL AND METHOD

We retrospectively analyzed 28 patients with Mason type III or IV radial head fractures treated with open reduction and internal fixation (ORIF) between 2020 and 2024. Clinical assessments included the visual analog scale (VAS) for pain, Mayo Elbow Performance (MEP) Score, and Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, as well as measurements of elbow flexion, extension, supination, and pronation. Radiographic evaluations assessed fracture union, loss of reduction, implant breakage or loosening, avascular necrosis, radiographic arthritis, and heterotopic ossification.

RESULTS

At a mean follow-up of 29.1 ± 20.1 months in 28 patients (16 M/12F; mean age 48.5 ± 12.6 years), mean elbow flexion was 120.4 ± 14.7, extension loss 10 ± 5.9, supination 68.9 ± 8.8°, and pronation 62.8 ± 7.1°, with mean VAS 2.3 ± 1.1, MEP Score 83.0 ± 8.9, and Quick-DASH 12.8 ± 7.6. Complete fracture union was achieved in 25 cases, partial union in 2, and asymptomatic nonunion in 1. Complications occurred in three patients (10%), including implant loosening, loss of reduction, heterotopic ossification, and avascular necrosis; two patients showed post-traumatic degenerative changes. One patient required K-wire removal due to migration and another underwent revision fixation with iliac crest bone graft for screw loosening/nonunion. No cases needed open arthrolysis or secondary radial head resection.

CONCLUSION

While osteosynthesis is effective in managing Mason type III and IV radial head fractures, having a radial head prosthesis available in the operating room can provide flexibility, especially in comminuted fractures, and potentially reduce the need for revision surgeries. These findings underscore the importance of adaptable surgical planning to improve outcomes in complex radial head fractures.

Trends in treatment and epidemiology of radial head fractures

Objective

We aimed to assess the recent trends in the demographics of radial head and neck fractures and their management based on displacement.

Methods

TriNetX was queried for cases from 1 January 2017, through 31 December 2022. ICD diagnosis codes were used to define patient cohorts with radial head or neck fractures. CPT codes were searched to determine the operative patient cohorts. All cases not included under any CPT codes were defined as the nonoperative cohort.

Results

A total of 103,432 patients were included. The female-to-male ratio was 4:3. The average age of individuals with radial head fractures was 43 ± 25 years, with a greater age in the replacement cohort compared to the fixation group. The incidence rates of displaced and nondisplaced fractures were similar across the years. Nonoperative management was overwhelmingly preferred over operative management. Regarding operative management, internal fixation rates were higher than replacement rates.

Conclusion

The trend of fracture incidence and the type of operative management has remained constant over the past 6 years. However, an increase in the number of radial head replacements is expected with an aging population. Moreover, radial head and neck fractures are among the benign injuries most frequently managed nonoperatively.

Radial head arthroplasty vs. open reduction and internal fixation in Mason 3 radial head fractures: meta-analysis of prospective trials

BACKGROUND

Radial head fractures (RHF) represent about one-third of all elbow fractures, comprising approximately 2%-5% of all fractures sustained. The aims of this systematic review and meta-analysis are as follows: (i) to compare complications rate in patients undergoing radial head arthroplasty (RHA) or open reduction and internal fixation as surgical treatments for Mason type 3 RHF; (ii) to compare clinical outcome and functional score in patients undergoing RHA or ORIF in Mason type 3 RHF.

METHODS

Following the preferred reporting items for systematic reviews and meta-analyses guidelines, a comprehensive literature systematic review of literature was conducted up to March 2024. All prospective studies were included. The analysis employed the log odds ratio (OR) and 95% confidence interval (CI) as the outcome measure.

RESULTS

Six studies were incorporated into the systematic review. A total of three studies, published between 2009 and 2021, were included in the meta-analysis. A cohort of 169 patients affected by Mason 3 RHFs was collected. The ORIF group included 65 patients, and 26 events of complications after ORIF were observed. RHA group, instead, consisted of 70 patients, and 8 events of complications were identified.

CONCLUSION

Our findings reveal that the Mason type 3 RHFs treated with open reduction and internal fixation, exhibits a higher risk of complications compared to those patients treated with RHA. Moreover, the standardized mean difference analysis suggests that the ORIF group demonstrates a lower mean Broberg and Morrey Elbow score in comparison to the RHA group, with a higher functional recovery in RHA group.

Comprehensive classification and its value of capitellar cartilage injury concomitant with radial head fracture

BACKGROUND

There are defects in the existing classification of capitellar cartilage injury (CCI) concomitant with radial head fracture (RHF). This study aimed to introduce a comprehensive classification of CCI and to analyze its surgical guidance value.

METHODS

According to the affected site and severity, CCI was classified into four types: Type I - partial-thickness loss of articular cartilage, Type II - full-thickness loss of articular cartilage, Type III - full-thickness loss of articular cartilage with subchondral bone loss, Type IV - full-thickness loss of articular cartilage with thin cortex loss on the border of the capitellum; Different types suggest different surgical methods. Between January 2017 and January 2023, this comprehensive CCI classification was applied in 31 operated patients with CCI concomitant with RHF. The ranges of motion (ROM), Mayo Elbow Performance Index (MEPI) score, Hospital for Special Surgery (HSS) score and visual analog scale (VAS) for pain, were used to evaluate the functional recovery of the affected limb.

RESULTS

Mason Type I-IV RHF accounted for 6.45%, 38.71%, 48.39%, and 6.45%, respectively. Type I-IV CCI accounted for 12.90%, 35.48%, 45.16% and 6.45%, respectively. There was no relationship between the CCI and RHF types (p > 0.05). At the end of the follow-up period of 11-26 months with an average of 16 months, the elbow flexion and extension ROM recovered to (147.39 ± 9.84)°, forearm rotation ROM recovered to (168.74 ± 11.70)°, MEPI score recovered to (89.19 ± 4.17), HSS score recovered to (88.74 ± 4.62), VAS score recovered to (0.50 ± 0.57), indicating significant differences compared to preoperative measurements (p < 0.05). According to the MEPI and HSS scores, the excellent and good rate of functional recovery was 100%.

CONCLUSION

Different types of CCI differ not only in pathology but also in treatment methods. Surgical strategy according to the comprehensive CCI classification introduced in this paper may lead to a satisfactory outcome.

Radial Head Fracture (Mason Type 4) Fixation With Headless Compression Screws: The "Tripod Technique"

Radial head fractures are fairly common fractures in the general population accounting for up to 30% of elbow fractures. The management of these fractures is controversial, specially in the higher grade of fractures. The current case report presents a middle-aged male patient with a fracture dislocation of the radial head in the dominant hand. After undergoing adequate investigations, the fracture was classified and managed with headless compression screws using the tripod technique. The management of the patient, preoperative planning, and the complications faced are mentioned in the current report. The patient on follow-up shows a good range of motion and an improved Mayo elbow score. Thus, stating good results can be obtained in Mason type 4 fractures using osteosynthesis with headless compression screws.

Anatomic Monopolar Press-fit Radial Head Arthroplasty; High Rate of Loosening at Mid-Term Follow Up

Introduction

Radial head arthroplasty (RHA) is used for the management of unstable or unreconstructable injuries of the radial head. Our aim was to investigate clinical and radiographic outcomes in patients treated with the Acumed anatomic radial head press-fit system for trauma.

Methods

Clinical and radiographic assessment of RHAs undertaken for trauma with minimum 2-year follow-up.

Results

16 consecutive patients, mean age 53 (21-82) and 66 month ± 27 (26-122) clinical follow-up were included. There were marked radiographic changes with 11/16 showing periprosthetic lucent lines and 13/16 showing subcollar osteolysis. Radiographic changes occurred early post-surgery. Stem loosening was associated with larger cantilever quotients (0.47 vs 0.38, p  =  0.004). Overall survivability was 81.2%, with 3 RHAs removed. Clinical outcomes for the retained RHAs were acceptable with mean flexion 134°, extension deficit of 10°, pronation of 82°, and supination of 73°. Mean VAS scores were 8.5 ±  14.4, QuickDASH 13.8 ±  18.9, Mayo Elbow Performance Scores were 91.5 ±  12.5 with no poor scores.

Conclusion

Mid-term clinical functional outcomes following the Acumed anatomic RHA are acceptable in most cases. However, in view of the extensive periprosthetic lucencies and surgical removal due to loosening, patients should be cautioned when consented for implantation of the prosthesis, especially if a large collar is anticipated.

The Emergent Evaluation and Treatment of Elbow and Forearm Injuries

This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications.

Use of surgical glue for Mason type III radial head fractures: A case report

RATIONALE

A Mason type III radial head fracture, which is characterized by comminuted fragments of the radial head, is a severe injury. Open reduction and internal fixation (ORIF) is an alternative treatment method; however, the technique of using an on-table reduction in combination with surgical glue is rarely reported.

PATIENT CONCERNS

A 48-year-old man was admitted to our department with complaints of elbow pain after falling down. Elbow radiography and computed tomography (CT) demonstrated characteristics of fractures before the operation.

DIAGNOSIS

Radiographic images showed a Mason type III radial head fracture.

INTERVENTIONS

The patient underwent ORIF at our hospital. During the operation, the technique of on-table reconstruction combined with surgical glue was used.

OUTCOMES

The patient recovered well and was able to participate in his usual work.

LESSONS

Mason type III radial head fractures could be treated with ORIF, and a satisfactory result could be anticipated, thus avoiding a radial head replacement or resection. Anatomical reduction of a comminuted radial head could be obtained via an on-table reconstruction and application of surgical glue.

[Typical fractures and dislocations of the elbow joint and their treatment]

Diagnosis and treatment of injuries to the elbow joint place high demands on the treating physicians. The complex anatomy of the elbow joint enables a wide range of movement and complex functions in everyday and professional life. These must be restored in the event of injury.Clinical and imaging-based diagnostic procedures serve to classify typical injuries of this joint according to a large variety of different pathologies. These include fractures of the distal humerus, the proximal ulna, and the radial head, as well as dislocations and dislocation fractures.The following article gives an overview of the most common of these injuries.