Abstract
Introduction
This study was performed to evaluate the long-term clinical and radiographic results of patients presenting with a radial head fracture who were treated surgically with a Judet Radial Floating Cup 2 (RFC 2) radial head prosthesis.
Materials and methods
This was a retrospective, monocentric, observational, multi-operator, and continuous study performed between July 1997 and June 2009 on the treatment of radial head fracture using an RFC 2 radial head prosthesis. The primary efficacy endpoint was the functional status of the operated elbow, evaluated using the Disability of Arm–Shoulder–Hand (Quick-DASH) score and the Mayo Elbow Performance Index (MEPI). The secondary endpoints were mobility and stability of the operated elbow, residual pain and grip strength, nature and rate of complications, as well as possible radiographic abnormalities during follow-up.
Results
Twenty-two patients were treated with the RFC 2 for radial head fractures over the study period. Three (13.6%) were lost to follow-up, including one death. Of the remaining 19 patients, three RFCs had to be removed (15.8%). The final analysis involved 16 patients. The mean follow-up was 144 months (range 109–225 months; standard deviation [SD] = 49.9 months) or 12 years. The average Quick-DASH score was 23.01/100 (range 0–50; SD = 7.8) and three cases were rated as having “excellent” results according to the MEPI (18.7%), nine cases were rated as having “good” results in (56.2%), and four cases were rated as having “average” results (25%). The average mobility values were: 132° of flexion (range 120°–150°; SD = 11), 14.5° of extension deficit (range 0°–40°; SD = 5), 84.4° of pronation (range 20°–90°; SD = 8°), and 67.7° of supination (range 25°–85°; SD = 10). All patients had a stable elbow. The average grip strength on the affected side thus corresponded to 79% (range 44–100%; SD = 8.3%) of the grip strength on the healthy side. Four patients (25%) developed complications: three cases of algodystrophic syndrome (18.7%) and one case of early dislocation (6.2%). Radiographic evaluation revealed that there was a periprosthetic radio-lucencies in eight patients (50%), periarticular ossifications in 12 patients (75%), and lysis of the capitulum in two patients. There was no significant difference in MEPI ratings between patients with and without a periprosthetic radio-lucencies (P = 0.8018).
Conclusions
Our results indicated that using the RFC 2 prosthesis to surgically treat radial head fractures provides good long-term functional results, including satisfactory mobility and stability.
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References
Duckworth AD, McQueen MM, Ring D (2013) Fractures of the radial head. Bone Jt J 95B:151–159. https://doi.org/10.1302/0301-620X.95B2.29877
Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. BJS 42:123–132. https://doi.org/10.1002/bjs.18004217203
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
Gabrion A, Havet E, Bellot F, Tranvan F, Mertl P, de Lestang M (2005) Recent fractures of the radial head associated with elbow instability treated with floating Judet prosthesis. Rev Chir Orthop Repar Appar Mot 91:407–414. https://doi.org/10.1016/s0035-1040(05)84357-0
Jensen SL, Olsen BS, Tyrdal S, Søjbjerg JO, Sneppen O (2005) Elbow joint laxity after experimental radial head excision and lateral collateral ligament rupture: efficacy of prosthetic replacement and ligament repair. J Shoulder Elbow Surg 14:78–84. https://doi.org/10.1016/j.jse.2004.05.009
Iannuzzi NP, Leopold SS (2012) In brief: the Mason classification of radial head fractures. Clin Orthop 470:1799–1802. https://doi.org/10.1007/s11999-012-2319-2
Adams JE, Sems SA, Steinmann SP (2017) Open treatment of radial head fractures. JBJS Essent Surg Tech 7:e35. https://doi.org/10.2106/JBJS.ST.15.00073
Stuffmann E, Baratz ME (2009) Radial head implant arthroplasty. J Hand Surg 34:745–754. https://doi.org/10.1016/j.jhsa.2009.01.027
Boulas HJ, Morrey BF (1998) Biomechanical evaluation of the elbow following radial head fracture. Comparison of open reduction and internal fixation vs. excision, silastic replacement, and non-operative management. Chir Main 17:314–320
Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJW (2004) The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Jt Surg Am 86:1730–1739. https://doi.org/10.2106/00004623-200408000-00018
Janssen RP, Vegter J (1998) Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Jt Surg Br 80:231–233. https://doi.org/10.1302/0301-620x.80b2.8255
Judet T, Garreau de Loubresse C, Piriou P, Charnley G (1996) A floating prosthesis for radial-head fractures. J Bone Jt Surg Br 78:244–249
Ring D, Quintero J, Jupiter JB (2002) Open reduction and internal fixation of fractures of the radial head. J Bone Jt Surg Am 84:1811–1815. https://doi.org/10.2106/00004623-200210000-00011
Judet T, Massin P, Bayeh PJ (1994) Radial head prosthesis with floating cup in recent and old injuries of the elbow: preliminary results. Rev Chir Orthop Repar Appar Mot 80:123–130
Viveen J, Kodde IF, Koenraadt KLM, Beumer A, The B, Eygendaal D (2017) Clinical and radiographic outcome of revision surgery of radial head prostheses: midterm results in 16 patients. J Shoulder Elbow Surg 26:394–402. https://doi.org/10.1016/j.jse.2016.09.047
Heijink A, Kodde IF, Mulder PGH, Van Dijk CN, Eygendaal D (2016) Cemented bipolar radial head arthroplasty: midterm follow-up results. J Shoulder Elbow Surg 25:1829–1838. https://doi.org/10.1016/j.jse.2016.05.017
Van Hoecke E, Van De Vijver A, Van Glabbeek F, Gielen J (2016) Long term results after bipolar radial head arthroplasty. Acta Orthop Belg 82:382–388
Chen AC-Y, Chou Y-C, Weng C-J, Cheng C-Y (2018) Long-term outcomes of modular metal prosthesis replacement in patients with irreparable radial head fractures. J Orthop Surg 13:134. https://doi.org/10.1186/s13018-018-0844-8
Popovic N, Lemaire R, Georis P, Gillet P (2007) Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface. J Bone Jt Surg Am 89:2469–2476. https://doi.org/10.2106/JBJS.F.00723
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–170. https://doi.org/10.1097/BOT.0000000000001063
Slobogean GP, Noonan VK, O’Brien PJ (2010) The reliability and validity of the Disabilities of Arm, Shoulder, and Hand, EuroQol-5D, Health Utilities Index, and Short Form-6D outcome instruments in patients with proximal humeral fractures. J Shoulder Elbow Surg 19:342–348. https://doi.org/10.1016/j.jse.2009.10.021
Morrey BF, Bryan RS, Dobyns JH, Linscheid RL (1981) Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Jt Surg Am 63:1050–1063
Broberg MA, Morrey BF (1986) Results of delayed excision of the radial head after fracture. J Bone Jt Surg Am 68:669–674
Doornberg JN, Linzel DS, Zurakowski D, Ring D (2006) Reference points for radial head prosthesis size. J Hand Surg 31:53–57. https://doi.org/10.1016/j.jhsa.2005.06.012
Moghaddam A, Raven TF, Dremel E, Studier-Fischer S, Grutzner PA, Biglari B (2016) Outcome of radial head arthroplasty in comminuted radial head fractures: short and midterm results. Trauma Mon. https://doi.org/10.5812/traumamon.20201
Levy JC, Formaini NT, Kurowicki J (2016) Outcomes and radiographic findings of anatomic press-fit radial head arthroplasty. J Shoulder Elbow Surg 25:802–809. https://doi.org/10.1016/j.jse.2015.11.014
Burkhart KJ, Mattyasovszky SG, Runkel M, Schwarz C, Küchle R, Hessmann MH et al (2010) Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg 19:965–972. https://doi.org/10.1016/j.jse.2010.05.022
Van Glabbeek F, Van Riet RP, Baumfeld JA, Neale PG, O’Driscoll SW, Morrey BF et al (2004) Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Jt Surg Am 86:2629–2635. https://doi.org/10.2106/00004623-200412000-00007
Doornberg JN, Parisien R, van Duijn PJ, Ring D (2007) Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J Bone Jt Surg Am 89:1075–1080. https://doi.org/10.2106/JBJS.E.01340
Allavena C, Delclaux S, Bonnevialle N, Rongières M, Bonnevialle P, Mansat P (2014) Outcomes of bipolar radial head prosthesis to treat complex radial head fractures in 22 patients with a mean follow-up of 50 months. Orthop Traumatol Surg Res OTSR 100:703–709. https://doi.org/10.1016/j.otsr.2014.06.019
Holmenschlager F, Halm J-P, Winckler S (2008) Les fractures fraîches de la tête radiale. /data/revues/00351040/00880004/387/
Hartzler RU, Morrey BF, Steinmann SP, Llusa-Perez M, Sanchez-Sotelo J (2019) Radial head reconstruction in elbow fracture-dislocation: monopolar or bipolar prosthesis?—PubMed—NCBI n.d. https://www.ncbi.nlm.nih.gov/pubmed/24867446 Accessed 14 Nov 2019
Mukka S, Sjöholm P, Perisynakis N, Wahlström P, Rahme H, Kadum B (2018) Radial head arthroplasty for radial head fractures: a clinical and radiological comparison of monopolar and bipolar radial head arthroplasty at a mean follow-up of 6 years. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-018-1042-4
Laumonerie P, Reina N, Gutierrez C, Delclaux S, Tibbo ME, Bonnevialle N et al (2018) Tight-fitting radial head prosthesis: does stem size help prevent painful loosening? Int Orthop 42:161–167. https://doi.org/10.1007/s00264-017-3644-6
Heijink A, Kodde IF, Mulder PGH, Veltman ES, Kaas L, van den Bekerom MPJ et al (2016) Radial head arthroplasty: a systematic review. JBJS Rev. https://doi.org/10.2106/jbjs.rvw.15.00095
Ricón FJ, Lajara F, Fuentes A, Aguilar ML, Boix A, Lozano JA (2018) Pyrocarbon arthroplasty in acute unreconstructable radial head fractures: mid-term to long term results. J Orthop Traumatol 19:13. https://doi.org/10.1186/s10195-018-0499-6
Gauci M-O, Winter M, Dumontier C, Bronsard N, Allieu Y (2016) Clinical and radiologic outcomes of pyrocarbon radial head prosthesis: midterm results. J Shoulder Elbow Surg 25:98–104. https://doi.org/10.1016/j.jse.2015.08.033
Laumonerie P, Tibbo ME, Kerezoudis P, Gauci MO, Reina N, Bonnevialle N et al (2018) Short to midterm outcomes of one hundred and seventy one MoPyC radial head prostheses: meta-analysis. Int Orthop 42:2403–2411. https://doi.org/10.1007/s00264-018-4070-0
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Montbarbon, B., Letissier, H., Dubrana, F. et al. The Radial Floating Cup radial head prosthesis to treat radial head fractures: functional and radiographic results after more than 12 years of mean follow-up. Arch Orthop Trauma Surg 141, 813–821 (2021). https://doi.org/10.1007/s00402-020-03559-4
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DOI: https://doi.org/10.1007/s00402-020-03559-4