A retrospective comparative cohort study of radial head arthroplasty versus resection in complex elbow dislocations

• Published in: Injury Vol. 51; pp. S89 - S93
• Main Authors: Mikel, Aburto Bernardo, Javier, Arnal Burró, Fausto, López Mombiela, Ángel, Pérez Martín, Irene, López Torres, Carlos, Álvarez González
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2020
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement - adverse effects; Arthroplasty, Replacement - methods; Complex elbow dislocation; Elbow Joint - diagnostic imaging; Elbow Joint - injuries; Elbow Joint - physiopathology; Elbow Joint - surgery; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fractures, Comminuted - diagnostic imaging; Fractures, Comminuted - surgery; Humans; Joint Dislocations - diagnostic imaging; Joint Dislocations - surgery; Male; Middle Aged; Postoperative Complications - therapy; Radial head arthroplasty; Radial head resection; Radiography; Radius - diagnostic imaging; Radius - surgery; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Ulna Fractures - diagnostic imaging; Ulna Fractures - surgery; Young Adult; Complex elbow dislocation; Radial head resection; Radial head arthroplasty
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2020.02.028

•Complex elbow dislocation represents a large number of different injuries subject to many different treatments.•Radial head arthroplasty is considered gold standard for the treatment of radial head fractures Mason III; however, multiple complications have been described related to them.•Radial head resection, although controversial, could be a valid alternative of treatment for this cases. The management of radial head fractures for the treatment of complex elbow dislocations remains controversial. Until the publication of recent therapeutic algorithms, different actions have been carried out, including resection or arthroplasty of the radial head. This study aims to compare the clinical and radiological results of these two techniques. A retrospective study was conducted between the years 2001 and 2016 in complex elbow dislocations associating comminuted fractures of the radial head (Mason type IV) for two cohorts: 20 patients who received a radial head prosthesis against 12 patients treated with resection. At the end of the follow-up, two functional valuation scales were applied: Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand score (DASH). Radiological study included the presence of post-traumatic osteoarthritis and heterotopic ossifications in both groups; and specific complications in the group of patients treated with an arthroplasty. The average age of the sample was 52.2 years in the prosthesis group, and 58.5 for the resection group, with a mean follow-up of 83.8 and 163 months respectively. No statistically significant differences were found in the mean values of the MEPS scale between the two groups (p = 0.5). The mean DASH score was significantly higher in the resection group (29.8 versus 10.3 with p = 0.006). A significantly higher rate of reinterventions and heterotopic ossifications was documented in the group of patients treated with radial head excision. The rate of specific radiological complications in the prosthesis group was 45%. Although radial head resection could be a valid treatment in this group of patients, radial head arthroplasty would remain as the main option for the treatment of these lesions. : Level IV; Case Series; Treatment Study