Treatment of chronic radial head dislocations in children.
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ABSTRACT:
SUBMITTER: Belangero WD
PROVIDER: S-EPMC2267559 | biostudies-other | 2007 Apr
REPOSITORIES: biostudies-other
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Project description:The treatment of chronic radial head dislocation remains controversial. Open reduction of the radial head in combination with correction of malalignment with ulnar osteotomy can be the key to a good surgical result. Between 2001 and 2006, 9 (6 female, 3 male, average age 8.4 (5-11) years) patients were treated surgically for chronic radial head dislocation by one surgeon. The time between trauma and surgery was 7 (1.5-14) months. The procedure consisted of open reduction of the dislocated radial head and reconstruction of the annular ligament in combination with an ulnar osteotomy. An upper arm cast was applied with the forearm in neutral rotation for six weeks. Plates were removed in all patients. Clinical and radiological evaluation took place preoperatively and after an average of 23 (10-49) months. At radiograph 8/9 showed a reduced radial head; in one an anterior subluxation was seen. The range of motion remained the same in 4 patients who had a full range of motion preoperatively. In 2/5 patients with loss of range of motion preoperatively, improvement was seen. There were no serious surgical complications beside one infection. Open reduction and corrective ulnar osteotomy shows good results for missed radial head dislocations in children.
| S-EPMC2321721 | biostudies-other
Project description:ObjectiveComplex elbow fractures are common injuries in young adults. Results in recent studies with various operative treatment protocols are equivocal. We compared the results of radial head arthroplasty, excision with osteosynthesis in such injuries at two follow-ups 1 year apart.MethodsThirty-five patients of complex elbow fracture-dislocations including, posterior/anterior olecranon dislocation of elbow, terrible triad injury, anteromedial facet of coronoid fracture, Type IV Monteggia fracture-dislocation and unclassified elbow dislocation were enrolled. They were managed operatively by standardized protocol similar to McKee et al. radial head reconstruction with miniplates, lag screws or non-operative treatment for undisplaced fractures. Arthroplasty of radial head with cemented prosthesis + LCL repair with suture anchor/transosseous tunnel was done. Coronoid and olecranon fixation was always performed. Patients were evaluated as follows: Q-DASH score, MEPI, pain according to VAS, range of motion, complications and radiographic findings and fracture union, and elbow instability.ResultsThe mean length of follow-up among the patients was 18 months. There were statistically significant differences between the DASH score/MEPS between radial head excision and replacement/reconstruction. Instability was significantly reduced in those with LCL reconstruction. Excising the comminuted radial head without replacement had the worst outcome. Best PROM was reported in patients with osteosynthesis.ConclusionProvided a standard protocol is applied, radial head osteosynthesis has preferable outcomes in terms of patient-related outcomes as compared to arthroplasty, although not statistically significant. Radial head excision though has acceptable outcomes but there is a restriction of movements especially flexion-extension. Acceptable rate of complications major or minor warrants need of secondary surgical procedures or a staged treatment.
| S-EPMC7609614 | biostudies-literature
Project description:Background The key to a successful result in the treatment of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) is the restoration of normal alignment of the carpal bones, followed by stable maintenance until healing. This article aimed to assess whether arthroscopic techniques are a reliable surgical option for the treatment of this challenging injury. Materials and Methods Twenty patients with an acute PLD or PLFD were treated by an arthroscopic technique. They were retrospectively reviewed at an average follow-up of 31.2 months (range 18-61 months). Functional outcomes were assessed with the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) score as well as radiographic evaluations. Description of Technique Arthroscopic reduction and percutaneous fixation was performed to the scapholunate and lunotriquetral intervals using Kirschner wires (K-wires) as joysticks as well as to the scaphoid using a cannulated headless screw for transscaphoid-type injuries. The K-wires were removed at 10 weeks postoperation. Results Overall functional outcomes according to the MMWS were rated as excellent in three patients, good in eight, fair in seven, and poor in two. The mean DASH score was 18, and the mean PRWE score was 30. On the basis of radiographic parameters, reduction obtained at the operation was maintained within normal ranges in 15 patients. No patient had developed arthritis by the last follow-up. Conclusions The medium-term results show that arthroscopic treatment can provide proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes for acute perilunate injuries. Level of Evidence Level IV.
| S-EPMC4408136 | biostudies-other
Project description:The use of bioabsorbable pins with prolonged degradation periods for fracture fixation has raised concerns about adverse soft tissue reactions, including seromas, discharging sinuses, or osteolytic changes. We asked whether bioabsorbable pins of self-reinforced polylactic acid polymer used in radial head fractures resulted in such reactions. We retrospectively reviewed 21 patients followed a minimum of 36 months (mean, 81 months; range, 36-136 months). There were nine Mason II, 10 Mason III, and two Mason IV fractures, which were evaluated clinically and radiographically. All fractures healed well with no radiographic signs of osteolysis. The mean Mayo Elbow Performance score was 93.8 (range, 20-100), which is comparable to the outcome of historical groups with radial head arthroplasty. The mean range of flexion of the elbow was 9 degrees to 132 degrees , with 79 degrees pronation and 77 degrees supination. The grip strength of the operated arm was not affected in comparison to the contralateral arm (mean range, 38.6 versus 40.9 kg). No material-related adverse effects were observed during and beyond the degradation period. Our data suggest concerns about soft tissue or bony reactions from these materials in radial head fractures are not justified.
| S-EPMC2311474 | biostudies-other
Project description:In chronic radial head dislocation cases, the radial head may enlarge and become dome-shaped. To date, there is no validated tool to quantify radial head deformation and predict its influence on surgical outcomes. This study assesses the potential value of volume and surface calculations obtained by quantitative three-dimensional computed tomography scanning (Q3DCT) in the workup for a corrective surgery in pediatric patients with missed Monteggia lesions. Ten consecutive pediatric patients with a missed Monteggia lesion were included (2012-2020). The volume and articular surface size of the radial head were calculated using Q3DCT, and a three-dimensional reconstruction of the articular surface relief was depicted in a heat map. The head-neck ratio was calculated and compared to Q3DCT data of missed Monteggia patients and their age-/sex-matched controls. The radial head volume and radial articular surface size did not differ significantly between patients with missed Monteggia lesions and age-/sex-matched controls (volume 1487 mm3 vs. 1163 mm3, P = .32; articular surface size 282 mm3 vs. 236 mm3, P = .33). Optically, heat maps of the articular surface of missed Monteggia patients did not differ notably from control heat maps. A higher head-neck ratio correlated to a larger radial head volume (Pearson r = 0.73; P = .2). Q3DCT may be an interesting tool in the preoperative workup of pediatric missed Monteggia lesions. Prospective research with larger cohort sizes and data that compares the affected side to the contralateral elbow is needed to assess its true clinical potential.
| S-EPMC10638549 | biostudies-literature
Project description:An acute perilunate wrist injury that is unreduced for more than 6 weeks results in severe disability, and even open reduction with stabilization through wide dorsal and volar approaches is technically challenging. This report describes an arthroscopic technique for reduction and percutaneous wire stabilization of a chronic perilunate wrist dislocations. The technique involves initial radiocarpal and midcarpal access through the 6R and 3-4 portals, and these portals are used for synovectomy and debridement of capsular flap tears. The midcarpal joint is accessed initially through the radiocarpal joint, and additional midcarpal portals are used for sequential perilunate adhesiolysis before carpal mobilization and reduction. A percutaneous wire drilled into the lunate is used as a joystick to manipulate the lunate into its anatomic alignment along the carpal bones, and percutaneous transcarpal wire fixation is performed to stabilize the carpus. Arthroscopic and fluoroscopic guidance is used to optimize anatomic reduction and to confirm stability. The wrist is immobilized for 6 weeks; the percutaneous wires are removed thereafter, and the wrist is mobilized. Overall, the arthroscopic technique provides a safe and reproducible method for treatment of this complex chronic injury.
| S-EPMC4912605 | biostudies-literature
Project description:Displaced radial head fractures are treated with open reduction and internal fixation using implants. Failure of fixation may occur in the presence of comminution and in multifragmentary fractures; open surgical approaches are necessary for removal of the implants and radial head resection. Arthroscopic radial head resection has been described as a minimally invasive and effective treatment for failed radial head fracture fixation; however, periarticular adhesions and prominent implants add to the complexity and technical difficulty of the procedure. The described technique uses 3 portals for adhesiolysis, implant removal, and radial head resection. Resection is performed in stages; smaller-diameter instruments are used to gain and improve access, and larger resectors are used subsequently. Adequacy of resection is assessed arthroscopically and with biplanar imaging. The arthroscopic technique avoids the need for an open surgical approach and prevents subsequent morbidity. In addition, the rehabilitation time is shorter and patient satisfaction is high.
| S-EPMC5040628 | biostudies-literature
Project description:BACKGROUND:The aim of this study was to compare the complete visible surface area of the radial head, neck, and coronoid in the Kaplan and Kocher approaches to the lateral elbow. The hypothesis was that the Kaplan approach would afford greater visibility due to the differential anatomy of the intermuscular planes. METHODS:Ten cadavers were dissected with the Kaplan and Kocher approaches, and the visible surface area was measured in situ using a 3-dimensional digitizer. Six measurements were taken for each approach by 2 surgeons, and the mean of these measurements were analyzed. RESULTS:The mean surface area visible with the lateral collateral ligament (LCL) preserved in the Kaplan approach was 616.6 mm2 in comparison with the surface area of 136.2 mm2 visible in the Kocher approach when the LCL was preserved. Using a 2-way analysis of variance, the difference between these 2 approaches was statistically significant. When the LCL complex was incised in the Kocher approach, the average visible surface area of the Kocher approach was 456.1 mm2 and was statistically less than the Kaplan approach. The average surface area of the coronoid visible using a proximally extended Kaplan approach was 197.8 mm2. CONCLUSIONS:The Kaplan approach affords significantly greater visible surface area of the proximal radius than the Kocher approach.
| S-EPMC6436133 | biostudies-literature
Project description:Radial-head subluxation is an easily identified and treated injury. We investigated whether triage nurses in the emergency department can safely reduce radial-head subluxation at rates that are not substantially lower than those of emergency department physicians.We performed an open, noninferiority, cluster-randomized control trial. Children aged 6 years and younger who presented to the emergency department with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours were assigned to either nurse-initiated or physician-initiated treatment, depending on the day. The primary outcome was the proportion of children who had a successful reduction (return to normal arm usage). We used a noninferiority margin of 10%.In total, 268 children were eligible for inclusion and 245 were included in the final analysis. Of the children assigned to receive physician-initiated care, 96.7% (117/121) had a successful reduction performed by a physician. Of the children assigned to receive nurse-treatment care, 84.7% (105/124) had a successful reduction performed by a nurse. The difference in the proportion of successful radial head subluxations between the groups was 12.0% (95% confidence interval [CI] 4.8% to 19.7%). Noninferiority of nurse-initiated radial head subluxation was not shown.In this trial, the rate of successful radial-head subluxation performed by nurses was inferior to the physician success rate. Although the success rate in the nurse-initiated care group did not meet the non-inferiority margin, nurses were able to reduce radial head subluxation for almost 85% of children who presented with probable radial-head subluxation.Clinical Trials.gov, no. NCT00993954.
| S-EPMC4050023 | biostudies-literature
Project description:Background: We conducted a retrospective study to compare reoperation/conversion rates and costs between open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) in patients with radial head/neck fractures. Methods: We examined the Humana Orthopedic data sets using the PearlDiver Application from January 2007 to June 2016 to identify patients with radial head and neck fractures with and without a concurrent elbow dislocation. Time to revision surgery, odds ratios, and survival curves for reoperations/conversions were calculated comparing ORIF and RHA. Results: A total of 7520 patients were identified who had undergone either ORIF or RHA. Overall, ORIF patients were less likely to undergo a conversion procedure (2.76% vs 7.03%) but more likely to undergo any reoperation (21.36% vs 17.63%) with a higher average cost ($19 688.46 vs $11 626.64). Patients who underwent ORIF without a concurrent elbow dislocation were also less likely to undergo a conversion procedure (2.12% vs 7.24%) but more likely to undergo any reoperation (20.22% vs 16.99%) with a higher average cost ($19 420.21 vs $11 123.61). Patients who underwent ORIF with a concurrent elbow dislocation were more likely to undergo both a conversion procedure (15.86% vs 6.39%) and any reoperation (44.98% vs 19.63%) with a higher average cost per patient ($24 999.62 vs $13 192.00). The average time to reoperation/conversion surgery was less than a year for all patient groups. Conclusions: Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures. RHA is less expensive and has fewer reoperations/conversions in short-term follow-up when compared with ORIF in radial head/neck fracture dislocations of the elbow.
| S-EPMC7818041 | biostudies-literature