The outcomes of radial head replacement in mason type III and IV radial head fractures
Date
2017
Authors
Bismilla, Muhammad Naadir
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Journal ISSN
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Abstract
Background
Fractures of the radial head are classified according to the Mason System modified by
Johnston. The fracture is managed according to its classification. Fractures of the
Mason Type III and IV are complex and management is controversial. The early
literature regarding the outcome of patients after arthroplasty of fracture dislocation of
the elbow is limited by small patient numbers, short-term follow-up, and high
complication rates. More recent literature has shown radial head replacement to have
better functional outcomes in the short to medium term.
Objectives
To assess outcomes of radial head replacements in acute 3 and 4 radial head
fractures by assessing elbow function, pain, elbow mobility post radial head
arthroplasty and complications.
Method
A retrospective study design was used. Records were retrieved for all 40 patients
who underwent a radial head replacement for a Mason III and IV fracture at Helen
Joseph Hospital over a ten year period. Participants were traced and asked to
complete a data sheet and undergo an examination by an interviewer. The data sheet
included demographics, surgical and injury details, as well as details relating to
function based on the Mayo Elbow Performance Score.
Results
Of a sample size n=16, 8 were male and 8 were female with an age range of 29 to 61
years and a mean age of 42.5 years. The length of follow up ranged from 2 to 8 years.
When asked about daily functionality, 4 reported difficulty with one of the five tasks
assessed on the Mayo Elbow Performance Score and 12 reported no difficulty with
any of the tasks assessed. Moderate pain was reported by 8 with the other 8 patients
reporting no pain.The flexion-extension arc ranged from 60º to 160º on examination
with an average of 111º. An arc of greater than 100º was achieved in 11 out of 16
patients . A total of five patients had an arc of greater than 50º but less than 100. No
patients had an arc less than 50º . Stability was assessed and scored. No study
participants had any gross instability. Moderate instability was detected in 6
participants. Complications were noted in 2 of the 16 participants (One posterior
interosseus nerve injury and one possible Essex-Lopresti injury).
The final MEPS scores showed that 8 patients had good results and 8 patients had
excellent functional outcomes with no fair or poor outcomes.
Conclusions
Good to excellent functional outcomes can be achieved with radial head
replacement in Mason III and IV fractures with minimal complications however,
longer term follow up with level one evidence is still needed.
Description
A research report submitted to the Faculty of Health Sciences, University of
the Witwatersrand, in partial fulfillment of the requirements for the degree of
Master of Medicine in the branch of Orthopaedic Surgery
Johannesburg
31 January 2017