The Journal of Bone and Joint Surgery (American) 83:1201-1211 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Arthroplasty with a Metal Radial Head for Unreconstructible Fractures of the Radial Head
Jaydeep K. Moro, MD, FRCSC,
Joel Werier, MD, FRCSC,
Joy C. MacDermid, BScPT, PhD,
Stuart D. Patterson, MBChB, FRCSC and
Graham J.W. King, MD, MSc, FRCSC
Investigation performed at The Hand and Upper Limb Centre, St.
Joseph’s Health Care, University of Western Ontario, London,
Ontario, Canada
Jaydeep K. Moro, MD, FRCSC
St. Joseph’s Health Care, McMaster University, 1 Young Street,
Suite 505, Hamilton, ON L8N 1T8, Canada
Joel Werier, MD, FRCSC
Joy C. MacDermid, BScPT, PhD
Graham J.W. King, MD, MSc, FRCSC
The Hand and Upper Limb Centre, St. Joseph’s Health
Care, University of Western Ontario, 268 Grosvenor Street, London,
ON N6A 4L6, Canada. E-mail address for G.J.W. King: gking{at}uwo.ca
Stuart D. Patterson, MBChB, FRCSC
Bond Clinic, 500 East Central Avenue, Winter Haven, FL 33880-3094
No benefits in any form have been received or will be received from
a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Background: Treatment of unreconstructible comminuted
fractures of the radial head remains controversial. There is limited
information on the outcome of management of these injuries with arthroplasty
with a metal radial head implant.
Methods: The functional outcomes of arthroplasties
with a metal radial head implant for the treatment of twenty-five
displaced, unreconstructible fractures of the radial head in twenty-four
consecutive patients (mean age, fifty-four years) were evaluated at
a mean of thirty-nine months (minimum, two years). There were
ten Mason type-III and fifteen Mason-Johnston type-IV injuries.
Two of these injuries were isolated, and twenty-three were
associated with other elbow fractures and/or ligamentous
injuries.
Results: At the time of follow-up, Short Form-36
(SF-36) summary scores suggested that overall health-related
quality of life was within the normal range (physical component = 47 ± 10, and mental component = 49 ± 13). Other outcome scales indicated mild disability
of the upper extremity (Disabilities of the Arm, Shoulder and Hand score = 17 ± 19), wrist (Patient-Rated Wrist Evaluation
score = 17 ± 21 and Wrist Outcome
Score = 60 ± 10), and elbow (Mayo
Elbow Performance Index = 80 ± 16).
According to the Mayo Elbow Performance Index, three results were
graded as poor; five, as fair; and seventeen, as good or excellent.
The poor and fair outcomes were associated with concomitant injury
in two patients, a history of a psychiatric disorder in three, comorbidity
in two, a Workers’ Compensation claim in two, and litigation
in one. Subjective patient satisfaction averaged 9.2 on a scale
of 1 to 10. Elbow flexion of the injured extremity averaged 140° ± 9°; extension, -8° ± 7°;
pronation, 78° ± 9°; and supination, 68° ± 10°. A significant loss of elbow flexion and extension
and of forearm supination occurred in the affected extremity, which also
had significantly less strength of isometric forearm pronation (17%)
and supination (18%) as well as significantly less grip
strength (p < 0.05). Asymptomatic bone lucencies surrounded
the stem of the implant in seventeen of the twenty-five elbows.
Valgus stability was restored, and proximal radial migration did
not occur. Complications, all of which resolved, included one complex
regional pain syndrome, one ulnar neuropathy, one posterior interosseous
nerve palsy, one episode of elbow stiffness, and one wound infection.
Conclusions: Patients treated with a metal radial
head implant for a severely comminuted radial head fracture will
have mild-to-moderate impairment of the physical capability of the
elbow and wrist. At the time of short-term follow-up, arthroplasty with
a metal radial head implant was found to have been a safe and effective
treatment option for patients with an unreconstructible radial head
fracture; however, long-term follow-up is still
needed.
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