Arthroplasty with a metal radial head for unreconstructible fractures of the radial head

Citation
Jk. Moro et al., Arthroplasty with a metal radial head for unreconstructible fractures of the radial head, J BONE-AM V, 83A(8), 2001, pp. 1201-1211
Citations number
41
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
Journal title
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME
ISSN journal
0021-9355 → ACNP
Volume
83A
Issue
8
Year of publication
2001
Pages
1201 - 1211
Database
ISI
SICI code
0021-9355(200108)83A:8<1201:AWAMRH>2.0.ZU;2-0
Abstract
Background: Treatment of unreconstructible comminuted fractures of the radi al head remains controversial. There is limited information on the outcome of management of these injuries with arthroplasty with a metal radial head implant. Methods: The functional outcomes of arthroplasties with a metal radial head implant for the treatment of twenty-five displaced, unreconstructible frac tures of the radial head in twenty-four consecutive patients (mean age, fif ty-four years) were evaluated at a mean of thirty-nine months (minimum, two years). There were ten Mason type-III and fifteen Mason-Johnston type-IV i njuries. Two of these injuries were isolated, and twenty-three were associa ted with other elbow fractures and/or ligamentous injuries. Results: At the time of follow-up, Short Form-36 (SF-36) summary scores sug gested that overall health-related quality of life was within the normal ra nge (physical component = 47 +/- 10, and mental component = 49 +/- 13). Oth er outcome scales indicated mild disability of the upper extremity (Disabil ities of the Arm, Shoulder and Hand score = 17 +/- 19), wrist (Patient-Rate d Wrist Evaluation score = 17 +/- 21 and Wrist Outcome Score = 60 +/- 10), and elbow (Mayo Elbow Performance Index = 80 +/- 16). According to the Mayo Elbow Performance Index, three results were graded as poor; five, as fair; and seventeen, as good or excellent. The poor and fair outcomes were assoc iated with concomitant injury in two patients, a history of a psychiatric d isorder in three, comorbidity in two, a Workers' Compensation claim in two, and litigation in one. Subjective patient satisfaction averaged 9.2 on a s cale of 1 to 10. Elbow flexion of the injured extremity averaged 140 degree s +/- 9 degrees; extension, -8 degrees +/- 7 degrees; pronation, 78 degrees +/- 9 degrees; and supination, 68 degrees +/- 10 degrees. A significant lo ss of elbow flexion and extension and of forearm supination occurred in the affected extremity, which also had significantly less strength of isometri c forearm pronation (17%) and supination (18%) as well as significantly les s grip strength (p < 0.05). Asymptomatic bone lucencies surrounded the stem of the implant in seventeen of the twenty-five elbows. Valgus stability wa s restored, and proximal radial migration did not occur. Complications, all of which resolved, included one complex regional pain syndrome, one ulnar neuropathy, one posterior interosseous nerve palsy, one episode of elbow st iffness, and one wound infection. Conclusions: Patients treated with a metal radial head implant for a severe ly comminuted radial head fracture will have mild-to-moderate impairment of the physical capability of the elbow and wrist. At the time of short-term followup, arthroplasty with a metal radial head implant was found to have b een a safe and effective treatment option for patients with an unreconstruc tible radial head fracture; however, long-term follow-up is still needed.