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Primäre posttraumatische Radiuskopfprothetik

Komplikationen

Primary radial head arthroplasty in trauma

Complications

  • Leitthema
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Zusammenfassung

Radiuskopffrakturen stellen die häufigste Frakturentität am Ellenbogen dar. Nichtdislozierte Frakturen werden konservativ, einfache dislozierte Frakturen operativ durch Reposition und Schraubenosteosynthese behandelt. Die Therapie der Mehrfragmentfrakturen ist Gegenstand der Diskussion. Bei Komplexverletzungen ist die Radiuskopfresektion obsolet, der Rekonstruktionsversuch mittels Osteosynthese durch hohe Komplikationsraten überschattet. Der endoprothetische Ersatz des Radiuskopfes stellt bei nicht oder nicht sinnvoll zu rekonstruierender Fraktur eine therapeutische Option mit guten funktionellen Ergebnissen dar. Durch das in der Regel niedrige Patientenalter und folglich hohe Aktivitätsniveau werden aber auch hohe Anforderungen gestellt. Unspezifisch allgemeine und spezifische prothesenassoziierte Komplikationen werden bei bis zu 40 % der Patienten beobachtet. Dieser Artikel soll typische Komplikationen nach primärer posttraumatischer Radiuskopfprothetik darstellen und Strategien zur Vermeidung aufzeigen.

Abstract

Radial head fractures are common injuries in elbow trauma. Non-displaced fractures are best treated conservatively. Simple but displaced fractures require anatomic reduction and fixation, typically using screws. The treatment course for complex fractures with multiple fragments is still being debated, as results are less predictable. Radial head resection is not advised if concomitant injuries of the coronoid process or the collateral ligaments with instability are present. Favorable outcomes following open reduction and fixation using plates were reported recently. However, complication rates are very high. Radial head replacement is a valuable tool in treating complex fractures of the radial head with predominantly good and excellent results. Patients who suffer radial head fractures are typically of a younger age, resulting in high functional demands. Certainly, unspecific and specific complications related to radial head arthroplasty were reported in up to 40 % of cases in an acute fracture setting. This article highlights common complications in radial head arthroplasty and aims to present strategies to avoid them.

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Literatur

  1. 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 31:51–61

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ (2005) The effect of radial head fracture size on elbow kinematics and stability. J Orthop Res 23:210–217

    Article  PubMed  Google Scholar 

  3. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ (2004) The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 86–A:1730–1739

    PubMed  Google Scholar 

  4. King GJ, Evans DC, Kellam JF (1991) Open reduction and internal fixation of radial head fractures. J Orthop Trauma 5:21–28

    Article  CAS  PubMed  Google Scholar 

  5. Ring D, Quintero J, Jupiter JB (2002) Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 84–A:1811–1815

    PubMed  Google Scholar 

  6. Hotchkiss RN (1997) Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg 5:1–10

    Article  PubMed  Google Scholar 

  7. Chen X, Wang SC, Cao LH 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 35:1071–1076

    Article  PubMed  Google Scholar 

  8. van Riet RP, van Glabbeek F (2007) History of radial head prosthesis in traumatology. Acta Orthop Belg 73:12–20

    PubMed  Google Scholar 

  9. Schmidt-Horlohe K, Bonk A, Hoffmann R (2010) Radiusköpfchenprothesen. In: Stöckle U (Hrsg) Ellenbogenchirurgie. Elsevier, München, S 165–172

    Google Scholar 

  10. Jensen SL, Olsen BS, Tyrdal S, Sojbjerg 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

    Article  PubMed  Google Scholar 

  11. Pike JM, Athwal GS, Faber KJ, King GJ (2009) Radial head fractures – an update. J Hand Surg Am 34:557–565

    Article  PubMed  Google Scholar 

  12. Zwingmann J, Bode G, Hammer T, Sudkamp NP, Strohm PC (2015) Radial head prosthesis after radial head and neck fractures – current literature and quality of evidence. Acta Chir Orthop Traumatol Cech 82:177–185

    CAS  PubMed  Google Scholar 

  13. Burkhart KJ, Mattyasovszky SG, Runkel M et al (2010) Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg 19:965–972

    Article  PubMed  Google Scholar 

  14. Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ (2001) Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am 83–A:1201–1211

    PubMed  Google Scholar 

  15. Ring D (2011) Radial head fracture: open reduction-internal fixation or prosthetic replacement. J Shoulder Elbow Surg 20:S107–S112

    Article  PubMed  Google Scholar 

  16. Knight DJ, Rymaszewski LA, Amis AA, Miller JH (1993) Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br 75:572–576

    CAS  PubMed  Google Scholar 

  17. Acevedo DC, Paxton ES, Kukelyansky I, Abboud J, Ramsey M (2014) Radial head arthroplasty: state of the art. J Am Acad Orthop Surg 22:633–642

    Article  PubMed  Google Scholar 

  18. Sarris IK, Kyrkos MJ, Galanis NN et al (2012) Radial head replacement with the MoPyC pyrocarbon prosthesis. J Shoulder Elbow Surg 21:1222–1228

    Article  PubMed  Google Scholar 

  19. Flinkkila T, Kaisto T, Sirnio K, Hyvonen P, Leppilahti J (2012) Short- to mid-term results of metallic press-fit radial head arthroplasty in unstable injuries of the elbow. J Bone Joint Surg Br 94:805–810

    Article  CAS  PubMed  Google Scholar 

  20. van Riet RP, Morrey BF, O’Driscoll SW, Van Glabbeek F (2005) Associated injuries complicating radial head fractures: a demographic study. Clin Orthop Relat Res 441:351–355

    Article  PubMed  Google Scholar 

  21. Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM (2014) Radial head replacement for acute complex fractures: what are the rate and risks factors for revision or removal? Clin Orthop Relat Res 472:2136–2143

    Article  PubMed  PubMed Central  Google Scholar 

  22. Grewal R, MacDermid JC, Faber KJ, Drosdowech DS, King GJ (2006) Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J Bone Joint Surg Am 88:2192–2200

    Article  PubMed  Google Scholar 

  23. Neuhaus V, Christoforou DC, Kachooei AR et al (2015) Radial head prosthesis removal: a retrospective case series of 14 patients. Arch Bone Jt Surg 3:88–93

    PubMed  PubMed Central  Google Scholar 

  24. 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 Joint Surg Am 89:1075–1080

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  26. Van Riet RP, Van Glabbeek F, Verborgt O, Gielen J (2004) Capitellar erosion caused by a metal radial head prosthesis. A case report. J Bone Joint Surg Am 86–A:1061–1064

    PubMed  Google Scholar 

  27. Van Glabbeek F, van Riet RP, Baumfeld JA et al (2005) The kinematic importance of radial neck length in radial head replacement. Med Eng Phys 27:336–342

    Article  PubMed  Google Scholar 

  28. Van Glabbeek F, Van Riet RP, Baumfeld JA et al (2004) Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg Am 86–A:2629–2635

    PubMed  Google Scholar 

  29. 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 Joint Surg Am 89:2469–2476

    Article  PubMed  Google Scholar 

  30. Birkedal JP, Deal DN, Ruch DS (2004) Loss of flexion after radial head replacement. J Shoulder Elbow Surg 13:208–213

    Article  PubMed  Google Scholar 

  31. Schnetzke M, Aytac S, Deuss M et al (2014) Radial head prosthesis in complex elbow dislocations: effect of oversizing and comparison with ORIF. Int Orthop 38:2295–2301

    Article  PubMed  Google Scholar 

  32. Cohn M, Glait SA, Sapienza A, Kwon YW (2014) Radiocapitellar joint contact pressures following radial head arthroplasty. J Hand Surg Am 39:1566–1571

    Article  PubMed  Google Scholar 

  33. Abdulla I, Langohr GD, Gladwell M et al (2015) The effect of fracture comminution on the reliability and accuracy of radial head sizing. J Shoulder Elbow Surg 24:364–368

    Article  PubMed  Google Scholar 

  34. Alolabi B, Studer A, Gray A et al (2013) Selecting the diameter of a radial head implant: an assessment of local landmarks. J Shoulder Elbow Surg 22:1395–1399

    Article  PubMed  Google Scholar 

  35. Rowland AS, Athwal GS, MacDermid JC, King GJ (2007) Lateral ulnohumeral joint space widening is not diagnostic of radial head arthroplasty overstuffing. J Hand Surg Am 32:637–641

    Article  PubMed  Google Scholar 

  36. Athwal GS, Rouleau DM, MacDermid JC, King GJ (2011) Contralateral elbow radiographs can reliably diagnose radial head implant overlengthening. J Bone Joint Surg Am 93:1339–1346

    Article  PubMed  Google Scholar 

  37. Athwal GS, Frank SG, Grewal R et al (2010) Determination of correct implant size in radial head arthroplasty to avoid overlengthening: surgical technique. J Bone Joint Surg Am 92(Suppl 1 Pt 2):250–257

    PubMed  Google Scholar 

  38. Frank SG, Grewal R, Johnson J et al (2009) Determination of correct implant size in radial head arthroplasty to avoid overlengthening. J Bone Joint Surg Am 91:1738–1746

    Article  PubMed  Google Scholar 

  39. Doornberg JN, Linzel DS, Zurakowski D, Ring D (2006) Reference points for radial head prosthesis size. J Hand Surg Am 31:53–57

    Article  PubMed  Google Scholar 

  40. Nordin M, Frankel VH (2001) Basic biomechanics of the musculoskeletal system. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  41. Allieu Y, Winter M, Pequignot JP, de Mourgues P (2008) Radial head prosthetic replacement with the Avatar implant. In: Celli A, Celli L, Morrey B (Hrsg) Treatment of elbow lesions. Springer, Milan, S 175–184

    Chapter  Google Scholar 

  42. Chanlalit C, Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW (2012) The biomechanical effect of prosthetic design on radiocapitellar stability in a terrible triad model. J Orthop Trauma 26:539–544

    Article  PubMed  Google Scholar 

  43. Chanlalit C, Shukla DR, Fitzsimmons JS et al (2011) Radiocapitellar stability: the effect of soft tissue integrity on bipolar versus monopolar radial head prostheses. J Shoulder Elbow Surg 20:219–225

    Article  PubMed  Google Scholar 

  44. Rotini R, Marinelli A, Guerra E, Bettelli G, Cavaciocchi M (2012) Radial head replacement with unipolar and bipolar SBi system: a clinical and radiographic analysis after a 2‑year mean follow-up. Musculoskelet Surg 96(Suppl 1):S69–S79

    Article  PubMed  Google Scholar 

  45. Hastings H 2nd, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10:417–437

    PubMed  Google Scholar 

  46. Hamid N, Ashraf N, Bosse MJ et al (2010) Radiation therapy for heterotopic ossification prophylaxis acutely after elbow trauma: a prospective randomized study. J Bone Joint Surg Am 92:2032–2038

    Article  PubMed  Google Scholar 

  47. Purcell DB, Matava MJ, Wright RW (2007) Ulnar collateral ligament reconstruction: a systematic review. Clin Orthop Relat Res 455:72–77

    Article  PubMed  Google Scholar 

  48. Van Riet R, Morrey BF (2010) Delayed valgus instability and proximal migration of the radius after radial head prosthesis failure. J Shoulder Elbow Surg 19:e7–e10

    Article  PubMed  Google Scholar 

  49. Schimizzi A, MacLennan A, Meier KM et al (2009) Defining a safe zone of dissection during the extensor digitorum communis splitting approach to the proximal radius and forearm: an anatomic study. J Hand Surg Am 34:1252–1255

    Article  PubMed  Google Scholar 

  50. Moon JG, Berglund LJ, Zachary D, An KN, O’Driscoll SW (2009) Radiocapitellar joint stability with bipolar versus monopolar radial head prostheses. J Shoulder Elbow Surg 18:779–784

    Article  PubMed  Google Scholar 

  51. Schneeberger AG, Sadowski MM, Jacob HA (2004) Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 86–A:975–982

    PubMed  Google Scholar 

  52. Schmidt-Horlohe K, Hoffmann R (2016) Bewegungsfixateur akut. In: Müller L‑P, Hollinger B, Burkhardt K (Hrsg) Expertise Ellenbogen. Thieme, Stuttgart, S 334–348

    Google Scholar 

  53. Fehringer EV, Burns EM, Knierim A et al (2009) Radiolucencies surrounding a smooth-stemmed radial head component may not correlate with forearm pain or poor elbow function. J Shoulder Elbow Surg 18:275–278

    Article  PubMed  Google Scholar 

  54. O’Driscoll SW, Herald JA (2012) Forearm pain associated with loose radial head prostheses. J Shoulder Elbow Surg 21:92–97

    Article  PubMed  Google Scholar 

  55. Chanlalit C, Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW (2012) Stress shielding around radial head prostheses. J Hand Surg Am 37:2118–2125

    Article  PubMed  Google Scholar 

  56. Pilliar RM, Lee JM, Maniatopoulos C (1986) Observations on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop Relat Res. doi:10.1097/00003086-198607000-00023

    PubMed  Google Scholar 

  57. Moon JG, Berglund LJ, Domire Z, An KN, O’Driscoll SW (2009) Stem diameter and micromotion of press fit radial head prosthesis: a biomechanical study. J Shoulder Elbow Surg 18:785–790

    Article  PubMed  Google Scholar 

  58. Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW (2012) Effect of stem length on prosthetic radial head micromotion. J Shoulder Elbow Surg 21:1559–1564

    Article  PubMed  Google Scholar 

  59. Chanlalit C, Shukla DR, Fitzsimmons JS, An KN, O’Driscoll SW (2011) Effect of hoop stress fracture on micromotion of textured ingrowth stems for radial head replacement. J Shoulder Elbow Surg 21:949–954

    Article  PubMed  Google Scholar 

  60. Shukla D, Fitzsimmons J, An KN, O’Driscoll S (2014) Prosthetic radial head stem pull-out as a mode of failure: a biomechanical study. Int Orthop 38:89–93

    Article  PubMed  Google Scholar 

  61. Everding NG, Maschke SD, Hoyen HA, Evans PJ (2013) Prevention and treatment of elbow stiffness: a 5‑year update. J Hand Surg Am 38:2496–2507 (quiz 2507)

    Article  PubMed  Google Scholar 

  62. Swanson AB, Jaeger SH, La Rochelle D (1981) Comminuted fractures of the radial head. The role of silicone-implant replacement arthroplasty. J Bone Joint Surg Am 63:1039–1049

    CAS  PubMed  Google Scholar 

  63. Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN (1994) Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg Br 76:78–81

    CAS  PubMed  Google Scholar 

  64. Bohl WR, Brightman E (1981) Fracture of a silastic radial-head prosthesis: diagnosis and localization of fragments by xerography. A case report. J Bone Joint Surg Am 63:1482–1483

    CAS  PubMed  Google Scholar 

  65. Van Glabbeek F, Van Riet R, Verstreken J (2001) Current concepts in the treatment of radial head fractures in the adult. A clinical and biomechanical approach. Acta Orthop Belg 67:430–441

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie und Orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstraße 430, 60389, Frankfurt am Main, Deutschland

    K. Schmidt-Horlohé, S. Buschbeck, D. Wincheringer & R. Hoffmann

  2. Orthopaedicum Wiesbaden, Friedrichstraße 29, 65185, Wiesbaden, Deutschland

    K. Schmidt-Horlohé

  3. Orthopädische Klinik König-Ludwig-Haus, Julius-Maximillians-Universität Würzburg, Würzburg, Deutschland

    M. Weißenberger

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  1. K. Schmidt-Horlohé
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  2. S. Buschbeck
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  3. D. Wincheringer
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  4. M. Weißenberger
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  5. R. Hoffmann
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Correspondence to K. Schmidt-Horlohé.

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K. Schmidt-Horlohé, S. Buschbeck, D. Wincheringer, M. Weißenberger und R. Hoffmann geben an, dass kein Interessenkonflikt besteht.

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Schmidt-Horlohé, K., Buschbeck, S., Wincheringer, D. et al. Primäre posttraumatische Radiuskopfprothetik. Orthopäde 45, 853–860 (2016). https://doi.org/10.1007/s00132-016-3330-1

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