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Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try?

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

A Correction to this article was published on 03 January 2020

This article has been updated

Abstract

Introduction

Complex radial head fractures are difficult to treat. In cases where stable fixation cannot be achieved, radial head resection or primary arthroplasty are frequently performed. Ex situ reconstruction of comminuted fractures may also be an option. This technique has widely been neglected in the literature, and only two small case series report satisfactory results. The aim of the present case series was to determine the functional and radiological outcomes of ex situ reconstructed Mason III and Mason IV fractures. We expect that the on-table reconstruction of comminuted radial head fractures will lead to bony union with no avascular necrosis in the postoperative course, which will demonstrate that this operative procedure is a reasonable option.

Patients and methods

Two Mason type III and seven Mason type IV fractures (including four Monteggia-like lesions) were reconstructed ex situ. The mean age of the patients was 47 years (range 22–64). The clinical examination included RoM tests, elbow stability tests, and a neurological examination. The functional outcome was assessed with the MEPS and DASH score. The radiographic examination included a.p. and lateral views of the elbow to detect non-unions, inadequacy or loss of reduction, radial head necrosis, heterotopic ossifications and signs of posttraumatic arthritis.

Results

The mean follow-up time was 39 months (range 11–64). The mean MEPS was 82 points (range 15–100), and the mean DASH score was 20 points (range 0–85). All ex situ-reconstructed radial heads survived, and no signs of avascular necrosis were observed. Bony union was achieved in all but one patient who presented with an asymptomatic non-union. Signs of posttraumatic arthritis were found in all patients. With regard to the radial head, neither secondary resection nor arthroplasty had to be performed. All patients returned to their pre-injury occupations.

Conclusion

Ex situ radial head reconstruction can be a reliable option in the surgical treatment of complex radial head fractures associated with severe elbow trauma. Even in the midterm follow-up, no signs of avascular necrosis were observed. Modern implants may even extend the indications for reconstruction in such cases.

Level of evidence

Level IV—retrospective cohort study

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Change history

  • 03 January 2020

    The original version of this article unfortunately contained a mistake.

  • 03 January 2020

    The original version of this article unfortunately contained a mistake.

References

  1. Kovar FM et al (2013) Incidence and analysis of radial head and neck fractures. World J Orthop 4(2):80–84

    Article  Google Scholar 

  2. Pike JM et al (2009) Radial head fractures—an update. J Hand Surg Am 34(3):557–565

    Article  Google Scholar 

  3. Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 42(172):123–132

    Article  CAS  Google Scholar 

  4. Johnston GW (1962) A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 31:51–56

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Al-Burdeni S et al (2015) Open reduction and internal fixation versus radial head arthroplasty in the treatment of adult closed comminuted radial head fractures (modified Mason type III and IV). Int Orthop 39(8):1659–1664

    Article  Google Scholar 

  6. Broberg MA, Morrey BF (1986) Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am 68(5):669–674

    Article  CAS  Google Scholar 

  7. Burkhart KJ et al (2015) Locking plate osteosynthesis of the radial head fractures : clinical and radiological results. Unfallchirurg 118(11):949–956

    Article  CAS  Google Scholar 

  8. Chen X et al (2011) Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multi-fragmented radial head fractures. Int Orthop 35(7):1071–1076

    Article  Google Scholar 

  9. Cronlein M et al (2017) Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 137(6):789–795

    Article  Google Scholar 

  10. Gao Y et al (2013) Surgical interventions for treating radial head fractures in adults. Cochrane Database Syst Rev 5:CD008987

    Google Scholar 

  11. Ikeda M et al. (2005) Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Jt Surg Am 87(1): 76–84.

    Article  Google Scholar 

  12. Ikeda M et al (2003) Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates. J Bone Jt Surg Br 85(7):1040–1044

    Article  CAS  Google Scholar 

  13. Lopiz Y et al (2016) Comminuted fractures of the radial head: resection or prosthesis? Injury 47(Suppl 3):S29–S34

    Article  Google Scholar 

  14. Nalbantoglu U et al (2007) Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation. J Hand Surg Am 32(10):1560–1568

    Article  Google Scholar 

  15. Pike JM et al (2014) Open reduction and internal fixation of radial head fractures: do outcomes differ between simple and complex injuries? Clin Orthop Relat Res 472(7):2120–2127

    Article  Google Scholar 

  16. Van Glabbeek F et al (2005) The kinematic importance of radial neck length in radial head replacement. Med Eng Phys 27(4):336–342

    Article  Google Scholar 

  17. van Riet RP, Sanchez-Sotelo J, Morrey BF (2010) Failure of metal radial head replacement. J Bone Jt Surg Br 92(5):661–667

    Article  Google Scholar 

  18. Businger A, Ruedi TP, Sommer C (2010) On-table reconstruction of comminuted fractures of the radial head. Injury 41(6):583–588

    Article  Google Scholar 

  19. Kiran Kumar GN et al (2015) On-table reconstruction and fixation of Mason type III radial head fractures. Chin J Traumatol 18(5):288–292

    Article  CAS  Google Scholar 

  20. Hastings H, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10(3):417–437

    PubMed  Google Scholar 

  21. Wu PH et al (2017) Prospective study of surgical fixation of radial head fractures using cannulated headless compression screws for simple and complex radial head fractures. J Orthop Surg (Hong Kong) 25(2):2309499017716278

    Google Scholar 

  22. Ruchelsman DE, Christoforou D, Jupiter JB (2013) Fractures of the radial head and neck. J Bone Jt Surg Am 95(5):469–478

    Article  Google Scholar 

  23. Sun H, Duan J, Li F (2016) Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis. Eur J Orthop Surg Traumatol 26(3):283–291

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Munster, Germany

    Jens Everding, Michael J. Raschke, Patrick Polgart, Niklas Grüneweller, Dirk Wähnert & Benedikt Schliemann

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  1. Jens Everding
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  2. Michael J. Raschke
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  3. Patrick Polgart
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  4. Niklas Grüneweller
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  5. Dirk Wähnert
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  6. Benedikt Schliemann
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Correspondence to Jens Everding.

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All procedures performed in this study were in accordance with the local IRB and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Everding, J., Raschke, M.J., Polgart, P. et al. Ex situ reconstruction of comminuted radial head fractures: is it truly worth a try?. Arch Orthop Trauma Surg 139, 1723–1729 (2019). https://doi.org/10.1007/s00402-019-03250-3

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  • DOI: https://doi.org/10.1007/s00402-019-03250-3

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