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Outcomes of press-fit radial head arthroplasty following complex radial head fractures - 05/08/20

Doi : 10.1016/j.otsr.2020.03.031 
Luis Lobo-Escolar a, c, , César Abellán-Miralles a, Anna Escolà-Benet b
a Department of Orthopaedics & Traumatology Surgery, Hospital Asepeyo Sant Cugat, Sant Cugat, Barcelona, Spain 
b Department of Orthopaedics & Traumatology Surgery, Hospital Universitario General de Cataluña, Sant Cugat, Barcelona, Spain 
c Autonomous University of Barcelona, Barcelona, Spain 

Corresponding author at: Department of Orthopaedics & Traumatology Surgery, Hospital Asepeyo Sant Cugat, 08174 Sant Cugat, Barcelona, Spain.Department of Orthopaedics & Traumatology Surgery, Hospital Asepeyo Sant CugatSant Cugat, Barcelona08174Spain
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 05 August 2020
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Abstract

Introduction

Press-fit radial head arthroplasty (RHA) is increasingly popular in treating complex radial head fractures. This study assessed the outcome of RHA, including the outcome following re-operation, and explored potentially influencing factors.

Hypothesis

Complex radial head fractures treated with press-fit radial head prosthesis would have a favourable outcome.

Material and methods

Data on all consecutive patients treated with anatomic press-fit RHA from February 2002 to February 2015 were analysed. Post-surgery clinical and X-rays assessments included a post-discharge evaluation of function. Standardised methods implemented include the assessment of range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and subjective satisfaction scales.

Results

Forty-five patients were recruited and 71% were classified in Mason IV and 62.2% had the “terrible triad”. Re-operation was performed in 26.7% and prosthesis removal in 15.6%. Mean follow-up was 140.8 months (95% CI 117.7–164) and prosthesis survival was 69.5% at 24 months. Mean MEPS before re-operations was 86.3±15.9. Pain and/or instability were the most common reasons for re-operation, and re-operations were significantly more frequent in patients having one or more “associated injuries” (p=0.05), but not the terrible triad; and in patients with radiological “loosening” signs (p<0.01). Subjective scores were relatively good in most patients, although the functionality perceived in the re-operation with implant removal group was rather low.

Discussion

Several studies of complex radial head fractures treated with press-fit radial head prosthesis have also shown favourable results, but the patients in such studies generally had less severe lesions. Moreover, differently from previous reports, this study with a long follow-up has included a younger population with high functionality requirements. Pain and/or instability, as observed in several previous reports, were the most common reasons for re-operation, but contrary to the expectation, the terrible triad was not associated with unfavourable outcome.

Conclusion

Treatment of complex fractures with press-fit radial head prosthesis, including re-operation with implant removal yields satisfactory results. Most scores of functional and subjective outcome improved following the re-intervention and most patients returned to their usual occupation.

Level of evidence

Level IV; case series; treatment study.

Le texte complet de cet article est disponible en PDF.

Keywords : Radial head, Fracture, Elbow prosthesis, Arthroplasty, Press-fit, Anatomic


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