Radial head prosthesis in complex elbow dislocations: effect of oversizing and comparison with ORIF View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-08-02

AUTHORS

Marc Schnetzke, Sara Aytac, Moritz Deuss, Stefan Studier-Fischer, Benedict Swartman, Matthias Muenzberg, Paul-Alfred Gruetzner, Thorsten Guehring

ABSTRACT

PurposeElbow dislocations with complex elbow instability (CEI) and unstable radial head fractures require reconstruction by open reduction and internal fixation (ORIF) if possible or alternatively by a radial head prosthesis. The aim of this study was to determine the differential outcome of both strategies and to investigate the contribution of prosthesis-related radiographic factors such as oversizing on clinical outcome.MethodsA total of 53 patients underwent ligament and coronoid refixation, and radial head reconstruction by ORIF (n = 18; group 1) or by monopolar modular prosthesis (n = 35; group 2). Patients were followed by the Mayo Elbow Performance Score (MEPS) and a radiological score including prosthesis oversizing, joint subluxation, ossifications, capitellar erosions, implant loosening and ulno-humeral osteoarthritis. To investigate the effect of oversizing, group 2 was subdivided by prosthesis overlenghtening ≥ 2 mm.ResultsA total of 42 patients (79.2 %) could be followed for 3.0 ± 1.3 years with an average MEPS of 76.8 ± 17.2. Patients with ORIF had slightly better MEPS (82.1 ± 9.9) as compared with group 2 (74.7 ± 19.1) though three ORIF patients required an early conversion to prosthesis. In group 2, oversizing occurred frequently and 50 % showed an overlenghtening ≥ 2 mm. Oversizing significantly decreased MEPS (63.2 ± 21.3 vs 84.7 ± 9.0; p = 0.001) and elbow range of motion and increased the occurrence of other radiological abnormalities and the risk for surgical revisions. The radiological score and prosthesis overlenghtening but not prosthesis diameter showed an inverse correlation with MEPS.ConclusionsIn CEI a radial head reconstruction with a prosthesis demonstrates similarly good clinical results as compared to ORIF in anatomically sized prosthesis, but prosthesis oversizing could induce other radiographic abnormalities with then deteriorated outcome. More... »

PAGES

2295-2301

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00264-014-2478-8

DOI

http://dx.doi.org/10.1007/s00264-014-2478-8

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1007351272

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25082181


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28 schema:description PurposeElbow dislocations with complex elbow instability (CEI) and unstable radial head fractures require reconstruction by open reduction and internal fixation (ORIF) if possible or alternatively by a radial head prosthesis. The aim of this study was to determine the differential outcome of both strategies and to investigate the contribution of prosthesis-related radiographic factors such as oversizing on clinical outcome.MethodsA total of 53 patients underwent ligament and coronoid refixation, and radial head reconstruction by ORIF (n = 18; group 1) or by monopolar modular prosthesis (n = 35; group 2). Patients were followed by the Mayo Elbow Performance Score (MEPS) and a radiological score including prosthesis oversizing, joint subluxation, ossifications, capitellar erosions, implant loosening and ulno-humeral osteoarthritis. To investigate the effect of oversizing, group 2 was subdivided by prosthesis overlenghtening ≥ 2 mm.ResultsA total of 42 patients (79.2 %) could be followed for 3.0 ± 1.3 years with an average MEPS of 76.8 ± 17.2. Patients with ORIF had slightly better MEPS (82.1 ± 9.9) as compared with group 2 (74.7 ± 19.1) though three ORIF patients required an early conversion to prosthesis. In group 2, oversizing occurred frequently and 50 % showed an overlenghtening ≥ 2 mm. Oversizing significantly decreased MEPS (63.2 ± 21.3 vs 84.7 ± 9.0; p = 0.001) and elbow range of motion and increased the occurrence of other radiological abnormalities and the risk for surgical revisions. The radiological score and prosthesis overlenghtening but not prosthesis diameter showed an inverse correlation with MEPS.ConclusionsIn CEI a radial head reconstruction with a prosthesis demonstrates similarly good clinical results as compared to ORIF in anatomically sized prosthesis, but prosthesis oversizing could induce other radiographic abnormalities with then deteriorated outcome.
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35 schema:keywords ConclusionsIn CEI
36 Elbow Performance Score
37 Mayo Elbow Performance Score
38 ORIF
39 ORIF patients
40 PurposeElbow dislocations
41 ResultsA total
42 abnormalities
43 aim
44 average Mayo Elbow Performance Score
45 better Mayo elbow performance scores
46 capitellar erosion
47 clinical outcomes
48 clinical results
49 comparison
50 complex elbow dislocations
51 complex elbow instability
52 contribution
53 conversion
54 coronoid refixation
55 correlation
56 diameter
57 differential outcomes
58 dislocations
59 early conversion
60 effect
61 effect of oversizing
62 elbow dislocation
63 elbow instability
64 erosion
65 factors
66 fixation
67 fractures
68 good clinical results
69 group 2
70 head fractures
71 head prosthesis
72 head reconstruction
73 implant loosening
74 instability
75 internal fixation
76 inverse correlation
77 joint subluxation
78 ligament
79 loosening
80 modular prosthesis
81 monopolar modular prosthesis
82 motion
83 occurrence
84 open reduction
85 ossification
86 osteoarthritis
87 outcomes
88 oversizing
89 patients
90 performance scores
91 prosthesis
92 prosthesis diameter
93 prosthesis-related radiographic factors
94 radial head fractures
95 radial head prosthesis
96 radial head reconstruction
97 radiographic abnormalities
98 radiographic factors
99 radiological abnormalities
100 radiological score
101 range
102 range of motion
103 reconstruction
104 reduction
105 refixation
106 results
107 revision
108 risk
109 scores
110 sized prostheses
111 strategies
112 study
113 subluxation
114 surgical revision
115 total
116 ulno-humeral osteoarthritis
117 unstable radial head fractures
118 years
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