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Clinical and radiological outcomes of autologous humeral bone grafting for radial head reconstruction: a minimum 2-year follow-up

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this prospective study was to assess the clinical and functional results of radial head reconstruction with an autologous bone graft from distal humerus in 12 patients, with a follow-up for a period of 24 months.

Methods

From March 2017 to June 2018, we surgically treated 12 patients using an autologous bone graft from the lateral distal metaphysis of the homolateral humerus. Patients were divided into two groups:

-Group A consisted of patients with previous failed ORIF for radial head fracture. Patients underwent revision surgery at an average time of 7 months (between 6 to 8 months) from the first surgery. All the patients reported pain during the elbow range of motion with no gross clinical signs or instability of the joint. They all presented standard X-ray and CT-scan of the elbow suggestive of non-union fracture. None of them presented osteoarthritic modification at the time of surgery.

-Group B consisted of patients reporting acute irreparable radial head fractures.

Patients were evaluated clinically at 6-, 12-, and 24-months duration according to Disabilities of the Arm. Shoulder and Hand (DASH), Mayo Elbow Performance Score (MEPS), and Visual analogue score for pain (VAS);, range of motion (ROM) was evaluated at 6 and 24 months after surgery. Plain radiographs on anteroposterior and lateral views of the elbow were evaluated at final follow-up.

Results

In both, groups (A and B) patients showed a significant improvement with regards to VAS, MEPS, and DASH at each follow-up (p < 0.05). X-rays showed complete bone healing in all patients with no sign of mobilisation or loosening of the screws. One case in group A presented asymptomatic partial ossification of LUCL.

No cases of fracture or residual pain at the donor site. Furthermore, no other complications such as infection, wound issues, elbow instability, elbow stiffness, ulnar neuritis, graft non-union were reported.

Conclusions

Distal humerus bone graft should be considered a reliable option for the treatment of acute fractures that are unrepairable fractures or revision surgery for failed ORIF of the radial head, especially among young patients where prosthesis may be reserved as a salvage procedure, and radial head resection is a damaging and is not considered desirable.

Level of evidence

Level IV – Prospective Case Series.

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Authors and Affiliations

  1. Humanitas Gavazzeni, Bergamo, Italy

    Gennaro Fiorentino, Mario Arduini & Francesco Catellani

  2. IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy

    Riccardo D’Ambrosi

  3. Humanitas San Pio X, Milan, Italy

    Federico Giuseppe Usuelli

Authors
  1. Gennaro Fiorentino
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  2. Mario Arduini
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  3. Riccardo D’Ambrosi
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  4. Federico Giuseppe Usuelli
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  5. Francesco Catellani
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Correspondence to Riccardo D’Ambrosi.

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Fiorentino, G., Arduini, M., D’Ambrosi, R. et al. Clinical and radiological outcomes of autologous humeral bone grafting for radial head reconstruction: a minimum 2-year follow-up. Eur J Orthop Surg Traumatol 32, 1153–1161 (2022). https://doi.org/10.1007/s00590-021-03094-x

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  • DOI: https://doi.org/10.1007/s00590-021-03094-x

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