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Surgical revision of radial head fractures: a multicenter retrospective analysis of 466 cases

Background - Radial head fractures lead to persisting disability in a considerable number of cases. This study aimed to investigate their most common revision causes and procedures. - Methods - This multicenter retrospective study reviewed the cases of 466 adult patients who had undergone surgical r...

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Main Authors: Hackl, Michael (Author) , Wegmann, Kilian (Author) , Hollinger, Boris (Author) , El-Zayat, Bilal F. (Author) , Seybold, Dominik (Author) , Gühring, Thorsten (Author) , Schnetzke, Marc (Author) , Schmidt-Horlohé, Kay (Author) , Greiner, Stefan (Author) , Lill, Helmut (Author) , Ellwein, Alexander (Author) , Glanzmann, Michael C. (Author) , Siebenlist, Sebastian (Author) , Jäger, Martin (Author) , Weber, Jörg (Author) , Müller, Lars P. (Author)
Format: Article (Journal)
Language:English
Published: 1 February 2019
In: Journal of shoulder and elbow surgery
Year: 2019, Volume: 28, Issue: 8, Pages: 1457-1467
ISSN:1532-6500
DOI:10.1016/j.jse.2018.11.047
Online Access:Verlag, Volltext: https://doi.org/10.1016/j.jse.2018.11.047
Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S1058274618308759
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Author Notes:Michael Hackl, MD, Kilian Wegmann, MD, PhD, Boris Hollinger, MD, Bilal F. El-Zayat, MD, PhD, Dominik Seybold, MD, PhD, Thorsten Gühring, MD, PhD, Marc Schnetzke, MD, Kay Schmidt-Horlohé, MD, Stefan Greiner, MD, PhD, Helmut Lill, MD, PhD, Alexander Ellwein, MD, Michael C. Glanzmann, MD, Sebastian Siebenlist, MD, PhD, Martin Jäger, MD, Jörg Weber, MD, Lars P. Müller, MD, PhD
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Summary:Background - Radial head fractures lead to persisting disability in a considerable number of cases. This study aimed to investigate their most common revision causes and procedures. - Methods - This multicenter retrospective study reviewed the cases of 466 adult patients who had undergone surgical revision after operative or nonoperative treatment of a radial head fracture. The initial diagnosis was a Mason type I fracture in 13.0%, Mason type II fracture in 14.6%, Mason type III fracture in 22.8%, Mason type IV fracture in 20.9%, terrible-triad injury in 12.8%, Monteggia-like lesion in 13.1%, and Essex-Lopresti lesion in 2.0%. Initial treatment was nonoperative in 30.2%, open reduction and internal fixation (ORIF) in 44.9%, radial head arthroplasty in 16.6%, radial head resection in 3.7%, sole treatment of concomitant injuries in 2.6%, and fragment excision in 2.0%. Up to 3 revision causes and procedures were recorded per case. - Results - The most common complications were stiffness (67.4%), instability (36.5%), painful osteoarthritis (29.2%), ORIF related (14.8%), nonunion or necrosis (9.2%), radial head arthroplasty related (7.5%), ulnar neuropathy (6.0%), and infection (2.6%). Revision procedures frequently included arthrolysis (42.1%), arthroplasty (24.9%), implant removal (23.6%), ligament repair or reconstruction (23.0%), débridement (14.2%), repeated ORIF (8.2%), and/or radial head resection (7.7%). Mason type I or II fractures were primarily revised because of stiffness and painful osteoarthritis. Complications after Mason type III fractures were predominantly ORIF related. Fracture-dislocations showed a wide range of complications, with instability and stiffness comprising the most common causes of revision. - Conclusions - The complications of radial head fractures are characteristic to their classification. Knowledge of these findings might guide surgeons in treating these injuries and may help counsel patients accordingly.
Item Description:Gesehen am 30.01.2020
Physical Description:Online Resource
ISSN:1532-6500
DOI:10.1016/j.jse.2018.11.047

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