Artikel
Outcomes of bipolar radial head prosthesis to treat complex radial head fractures
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Veröffentlicht: | 10. Oktober 2016 |
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Background: Radial head replacement is indicated to treat complex proximal radial fractures that are not treatable to open reduction and internal fixation.
Hypotethis: Implantation of a bipolar radial head prosthesis after radial head excision ensures stability of the elbow and forearm, thereby promoting ligament healing and restoring elbow and arm function.
Materials and Methods: We analyzed 15 patients with a mean age of 62 years (49-80) treated with implantation of a bipolar radial head prosthesis (Tornier, CRF II Bipolar Radial Head Prosthesis®) since 2001. 4 Patients showed a radial head fracture Mason III, 4 Patients a fracture type Mason IV and 7 a luxation fracture of the elbow. The mean follow-up was 52 months (6-170). The procedure was performed in the acute setting in 13 patients and in 2 patients as a change of treatment after ORIF. Clinical, ultrasonographic assessments were done. Final functional outcome was assessed by Quick-Disability of the Arm Shoulder and Hand-score (Q-DASH), ROM measurement, Strength Test with a Jamar® Hydraulic Hand Dynamometer, Instability test with ultrasonographic dynamic measurement.
Results: The mean Q-DASH was 27,8 (0-73). Mean pain level on the visual analog scale (0-10) was 2,7. Mean satisfaction level was 7,9 on a visual analog scale 0-10. Deficient extension persisted in 13 patients (mean 10 degrees), Average flexion was 121 degrees, Mean motion arcs were 111° in flexion-extension and 147° in pronation-supination. Mean forearm strength in mid- flexion 65%, respectively, of those on the contralateral normal side. Full sagittal and frontal stability in valgus was preserved in 7 patients. 1st degree instability in valgus stress showed in 8 patients. Ultrasonographic measurement of varus/valgus instability showed a mean increased instability of 0,56 mm. Prosthesis removal was required in 1 patient.
Discussion: Outcomes after Tornier, CRF II Bipolar Radial Head Prosthesis® implantation were surprisingly good, especially with patients of an isolated complex radial head fracture. The patients with a complex elbow trauma with associated injuries to bones and ligaments show a worse outcome an a non-negligible complication rate. Over all the results are similar to those reported in the literature.