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Journal Club

March 2010

Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old

Samuel A. Antuña, José M. Sánchez-Márquez and Raúl Barco J Bone Joint Surg Am. 2010;92:558-566

Shoulder and Elbow Unit, Hospital Universitario La Paz, Madrid, Spain

Background

• Radial head resection previously treatment of choice for inoperable fractures
  
  • concerns regarding
    • Alters elbow kinematics
    • valgus instability,
    • stiffness
    • proximal migration of the radius
      
• Radial head replacement becoming more popular
  
• Aim to review long term results of radial head resection withfracturenot associated with elbow instability

Method

• 26 patients
  • <40 yrs old retrospective review of minimum 15 years
    
  • Isolated radial head fracture treatment with resection
    • 6 patients Mason II,
    • 20 patients Mason III
      
• Exclusion criteria:
  • documented elbow dislocation,
  • associated elbow fractures,
  • MCL injury,
  • failure of
    • non-operative or operative treatment,
  • delayed radial head excision
    
• Outcomes evaluated with:
  • Mayo Elbow Performance Score (MEPS),
  • Disabilities of Arm, Shoulder and Hand Score (DASH)
    
• Radiographic Assessment of:
  • osteoarthritic changes,
  • carrying angle,
  • radial shortening

Results

• Elbow pain:
  • 21 patients no pain,
  • 3 patients mild,
  • 2 patients moderate
    
• Wrist pain:
  • 2 patients mild pain,
  • 1 patient moderate,
  • 1 patient had DRUJ instability
    
• Ulna Nerve Irritation
  • 3 patients
• ROM:
  • mean arc of motion 9° to 139°,
  • mean pronation 84°,
  • mean supination 85°
    
• Strength:
  • 19 elbows had normal strength c.f. opposite side
    
• Instability:
  • 4 patients elbow instability, 1 patient DRUJ instability
    
• MEPS: mean score 95 points
  
• DASH: mean score 6 points
  
• Mean carrying angle 21° Vs 10° on opposite side
  
• XR changes of OA:
  • mild 17 patients,
  • moderate 9 patients

Discussion

• Radial head is an important stabiliser of elbow and forearm
  
• treatment of unstable elbow fracture dislocations must restore radiocapitellar articulation
  
• Consider internal fixation or arthroplasty rather than resection to avoid delayed complications:
  
  • Pain
    
  • Instability
    
  • Proximal radial translation
    
  • Decreased strength
    
  • Osteoarthritis
    
  • Cubitus valgus
    
• Kinematics of elbow are considerably altered after radial head excision:
  
  • Unrecognised acute ligamentous damage at time of injury
    
  • Progressive stretch of medial ligament complex over time
    
• Pros:
  • longest follow up series to date, specifically analyses results in young patients
    
• Cons:
  • no standard to compare, small patient numbers