RADIAL HEAD RESCTION - IS IT STILL VALUABLE SURGICAL SOLUTION?
Abstract
The aim of the present study was to review the functional and radiological results following the traditional technique on radial head resection for unreconstructable radial head fractures.Clinical evaluation included the Disabilities of the Arm, Shoulder and Hand questionnaire. Elbow pain was graded as none, mild, moderate or severe. A visual analogue scale was used for the assessment of patient satisfaction. We assessed the difference in the strength between both sides, valgus laxity of the elbow, posterolateral instability and grip strength. On the basis of the interview and the physical examination, Mayo Elbow Performance S was evaluated. Radiographic review consisted of evaluating for proximal migration of the radius, radial shortening and ulnar variance. 21 patents with a mean age of 36 years at the time of injury that underwent radial head resection were included. The mean value of Visual Analogue Scale satisfaction score was 9 (range 4-10; Std =1.54). Mean range of motion was 9° of extension (range 0° to 32°) and 135° of flexion (range 70° to 145°). Mean total arc was 130° (range 70° to 145°). Eighteen patients (86%) had a functional arc of motion (≤30° to ≥130°). Mean value of MEPS was 95 points (range 60-100 points; Std=8.76). Increased ulnar variance was 17 patients. Three patients had proximal migration of the radius (> 5mm). Our data suggest that comminuted fractures of the radial head may be treated with radial head excision with satisfactory long-term functional outcome. Despite popularity of radial head prostheses, good functional result can be obtained even without radial head replacement.
Keywords:radial head, fracture, resection, outcome.
References
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2.Court-Brown CM, Aitken SA, Forward D, O’Toole RV. The epidemiology of fractures. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P, eds. In: Rockwood and Green’s fractures in adults. Seventh ed. Philadelphia: Lippincott, Williams and Wilkins, 2010:53–84.
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6.David E. Ruchelsman, MD, Dimitrios Christoforou, MD, and Jesse B. Jupiter, MD. Fractures of the Radial Head and Neck. J Bone Joint Surg Am. 2013;95:469-78.
7. van Riet RP, Van Glabbeek F, Neale PG, Bortier H, An KN, O’Driscoll SW. The noncircular shape of the radial head. J Hand Surg Am. 2003 Nov;28(6):972-8.
8.Koslowsky TC, Germund I, Beyer F, Mader K, Krieglstein CF, Koebke J. Morphometric parameters of the radial head: an anatomical study. Surg Radiol Anat. 2007 Apr;29(3):225-30. Epub 2007 Mar 7.
9.Koslowsky TC, Beyer F, Germund I, Mader K, Jergas M, Koebke J. Morphometric parameters of the radial neck: an anatomical study. Surg Radiol Anat. 2007 Jun;29(4):279-84. Epub 2007 May 10.
10.Swieszkowski W, Skalski K, Pomianowski S, Kedzior K. The anatomic features of the radial head and their implication for prosthesis design. Clin Biomech (Bristol, Avon). 2001 Dec;16(10):880-7.
11.Van Riet RP, Van Glabbeek F, Verborgt O, Gielen J. Capitellar erosion caused by a metal radial head prosthesis: a case report. J Bone Joint Surg [Am] 2004;86-A:1061–1064.
12.Yian E, Steens W, Lingenfelter E, Schneeberger AG. Malpositioning of radial head prostheses: an in vitro study. J Shoulder Elbow Surg 2008;17:663–670.
13.Bohl WR, Brightman E. Fracture of a silastic radial-head prosthesis: diagnosis and localization of fragments by xerography: a case report. J Bone Joint Surg [Am] 1981;63-A:1482–1483.
14. Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN. Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg [Br] 1994;76-B:78–81.
15. Clembosky G, Boretto JG. Open reduction and internal fixation versus prosthetic replacement for complex fractures of the radial head. J Hand Surg Am 2009;34:1120–1123.
16.Capomassi MA, Clembosky GA. Use of a polymethacrylate radial head spacer in temporary reconstruction of complex radial head fracture with associated elbow instability. Tech Hand Up Extrem Surg 2010;14:252–258.
17.Ricón FJ, Sánchez P, Lajara F, et al. Result of a pyrocarbon prosthesis after comminuted and unreconstructable radial head fractures. J Shoulder Elbow Surg 2012;21:82–91.
18. Van Glabbeek F, Van Riet RP, Baumfeld JA, et al. Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg [Am] 2004;86-A:2629–2635.
19. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42:123–132.
20. Johnston GW. A follow-up of one hundred cases fracture of the head of the radius with a review of the literature. Ulster Med J. 1962;31:51–56.
21. Hammacher ER, van der Werken C. Radial head fracture: operative or conservative treatment? The Greek temple model. Acta Orthop Belg. 1996;62(suppl 1):112–115.
22.Geel CW, Palmer AK, Ruedi T, et al. Internal fixation of proximal radial head fractures. J Orthop Trauma. 1990;4:270–274.
23.Heim U. Surgical treatment of radial head fracture [in German]. Z Unfallchir Versicherungsmed. 1992;85:3–11.
24. Ikeda M, Sugiyama K, Kang C, et al. Comminuted fractures of the radial head, comparison of resection and internal fixation. J Bone Joint Surg Am.2005;87:76–84.
25. Ikeda M, Yamashina Y, Kamimoto M, et al. Open reduction and internal fixation of comminuted fractures of the radial head using low-profile miniplates. J Bone Joint Surg Br. 2003;85:1040–1044.
26. Janssen RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br. 1998;80:231–233.
27. King GJ, Evans DC, Kellarn JF. Open reduction and internal fixation of radial head fractures. J Orthop Trauma. 1991;5:21–28.
28.Knight DJ, Rymaszewski LA, Amis AA, et al. Primary replacement of the fractured radial head with metal prosthesis. J Bone Joint Surg Br. 1993;75:572–576.
29.Mancini GB, Fiacca C, Picuti G. Resection of the radial capitellum. Longterm results. Ital J Orthop Traumatol. 1989;15:295–302.
30.Struijs PA, Smit G, Steller EP. Radial head fractures: effectiveness of conservative treatment versus surgical intervention. A systematic review.Arch Orthop Trauma Surg. 2007;127:125–130.
31. Esser RD, Davis S, Taavao T. Fractures of the radial head treated by internal fixation: late results in 26 cases. J Orthop Trauma. 1995;9:318–323.
32. Pelto K, Hirvensalo E, Bostman O, et al. Treatment of radial head fractures with absorbable polyglycolide pins: a study on the security of the fixation in 38 cases. J Orthop Trauma. 1994;8:94–98.
33.RingD, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002;84:1811-1815.
34.Samuel A. Antu˜na, MD, PhD, FEBOT, Jos´e M. S´anchez-M´arquez, MD, and Ra ´ ul Barco, MD, FEBOT. Long-Term Results of Radial Head Resection Following Isolated Radial Head Fractures in Patients Younger Than Forty Years Old. J Bone Joint Surg Am. 2010;92:558-66.
35. Harrington IJ, Sekyi-Out A, Barrington TW, et al. The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long term review. J Trauma. 2001;50:46–52.
36.Herbertsson P, Josefsson PO, Hasserius R, et al. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004;86:1925–1930.
37.Judet T, Garreau DL, Piriou P, et al. A floating prosthesis for radial-head fractures. J Bone Joint Surg Br. 1996;78:244–249.
38.Judet T. Results of acute excision of the radial head in elbow radial head fracture–dislocations. J Orthop Trauma. 2001;15:308–309.
39. Moro JK, Werier J, MacDermid JC, et al. Arthroplasty with a metal radial head for unreconstructable fractures of the radial head. J Bone Joint Surg Am. 2001;83:1201–1211.
40.Sanders RA, French HG. Open reduction and internal fixation of comminuted radial head fractures. Am J Sports Med. 1986;14:130–135.
41.Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986;68:669-74.
42.O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the Elbow. J Bone Joint Surg Am. 1991;73:440-6.
43.Morrey BF, O’Driscoll SW. Lateral collateral ligament injury. In: Morrey BF, editor. The elbow and its disorders. 3rd ed. Philadelphia: WB Saunders; 2000;556-62.
44.Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 2nd ed. Philadelphia: WB Saunders; 1993;86-97.
45.Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases.Br J Surg. 1954 Sep;42(172):123-32.
46.Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of radial head and neck fractures. J Hand Surg Am. 2012 Jan;37(1):112-9. Epub 2011 Nov 25.
47.Michael Lapner, MD, BSc, FRCSC, and Graham J.W. King, MD, MSc, FRCSC. Radial Head Fractures. J Bone Joint Surg Am. 2013;95:1136-43.
48.Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004 Aug;86(8):1730-9.
49. Jensen SL, Olsen BS, Søjbjerg JO. Elbow joint kinematics after excision of the radial head. J Shoulder Elbow Surg. 1999 May Jun;8(3):238-41.
50. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004;86:1730-9. Faldini C, Pagkrati S, Grandi G, Digennaro V, Lauretani G, Faldini
51.Giannini S. What happens to the elbow joint after fractured radial head excision? Clinical and radiographic study at a mean 15-year follow-up. J Orthop Traumatol. 2006;7:126-30.
52.Goldberg I, Peylan J, Yosipovitch Z. Late results of excision of the radial head for an isolated closed fracture. J Bone Joint Surg Am. 1986;68:675-9.
53.Coleman DA, Blair WF, Shurr D. Resection of the radial head for fracture of the radial head. Long-term follow-up of seventeen cases. J Bone Joint Surg Am. 1987;69:385-92.
54.Miralles FA, Sebastia´c E, Cebria´cn R, Lizaur A. Resultados funcionales de las resecciones de la cabeza radial tras su fractura. Rev Ortop Traumatol. 2004;48:12-6.
55. Fuchs S, Chylarecki C. Do functional deficits result from radial head resection? J Shoulder Elbow Surg. 1999;8:247-51.
56.Janssen RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br. 1998;80: 231-3.
57.Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004;86:1925-30.
58. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg Am. 2005;87:76-84.
59. Morrey BF, Chao EY, Hui FC. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am. 1979;61:63-8.
60.Sowa DT, Hotchkiss RN, Weiland AJ. Symptomatic proximal translation of the radius f ollowing radial head resection. Clin Orthop Relat Res. 1995;317:106-13.
2.Court-Brown CM, Aitken SA, Forward D, O’Toole RV. The epidemiology of fractures. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P, eds. In: Rockwood and Green’s fractures in adults. Seventh ed. Philadelphia: Lippincott, Williams and Wilkins, 2010:53–84.
3.Duckworth AD, Clement ND, Jenkins PJ, et al. The epidemiology of radial head and neck fractures. J Hand Surg Am 2012;37:112–119.
4.Kaas L, van Riet RP, Vroemen JP, Eygendaal D. The epidemiology of radial head fractures. J Shoulder Elbow Surg 2010;19:520–523.
5.Davidson PA, Moseley JB Jr, Tullos HS. Radial head fracture: a potentially complex injury. Clin Orthop Relat Res 1993;297:224–230.
6.David E. Ruchelsman, MD, Dimitrios Christoforou, MD, and Jesse B. Jupiter, MD. Fractures of the Radial Head and Neck. J Bone Joint Surg Am. 2013;95:469-78.
7. van Riet RP, Van Glabbeek F, Neale PG, Bortier H, An KN, O’Driscoll SW. The noncircular shape of the radial head. J Hand Surg Am. 2003 Nov;28(6):972-8.
8.Koslowsky TC, Germund I, Beyer F, Mader K, Krieglstein CF, Koebke J. Morphometric parameters of the radial head: an anatomical study. Surg Radiol Anat. 2007 Apr;29(3):225-30. Epub 2007 Mar 7.
9.Koslowsky TC, Beyer F, Germund I, Mader K, Jergas M, Koebke J. Morphometric parameters of the radial neck: an anatomical study. Surg Radiol Anat. 2007 Jun;29(4):279-84. Epub 2007 May 10.
10.Swieszkowski W, Skalski K, Pomianowski S, Kedzior K. The anatomic features of the radial head and their implication for prosthesis design. Clin Biomech (Bristol, Avon). 2001 Dec;16(10):880-7.
11.Van Riet RP, Van Glabbeek F, Verborgt O, Gielen J. Capitellar erosion caused by a metal radial head prosthesis: a case report. J Bone Joint Surg [Am] 2004;86-A:1061–1064.
12.Yian E, Steens W, Lingenfelter E, Schneeberger AG. Malpositioning of radial head prostheses: an in vitro study. J Shoulder Elbow Surg 2008;17:663–670.
13.Bohl WR, Brightman E. Fracture of a silastic radial-head prosthesis: diagnosis and localization of fragments by xerography: a case report. J Bone Joint Surg [Am] 1981;63-A:1482–1483.
14. Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN. Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg [Br] 1994;76-B:78–81.
15. Clembosky G, Boretto JG. Open reduction and internal fixation versus prosthetic replacement for complex fractures of the radial head. J Hand Surg Am 2009;34:1120–1123.
16.Capomassi MA, Clembosky GA. Use of a polymethacrylate radial head spacer in temporary reconstruction of complex radial head fracture with associated elbow instability. Tech Hand Up Extrem Surg 2010;14:252–258.
17.Ricón FJ, Sánchez P, Lajara F, et al. Result of a pyrocarbon prosthesis after comminuted and unreconstructable radial head fractures. J Shoulder Elbow Surg 2012;21:82–91.
18. Van Glabbeek F, Van Riet RP, Baumfeld JA, et al. Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg [Am] 2004;86-A:2629–2635.
19. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42:123–132.
20. Johnston GW. A follow-up of one hundred cases fracture of the head of the radius with a review of the literature. Ulster Med J. 1962;31:51–56.
21. Hammacher ER, van der Werken C. Radial head fracture: operative or conservative treatment? The Greek temple model. Acta Orthop Belg. 1996;62(suppl 1):112–115.
22.Geel CW, Palmer AK, Ruedi T, et al. Internal fixation of proximal radial head fractures. J Orthop Trauma. 1990;4:270–274.
23.Heim U. Surgical treatment of radial head fracture [in German]. Z Unfallchir Versicherungsmed. 1992;85:3–11.
24. Ikeda M, Sugiyama K, Kang C, et al. Comminuted fractures of the radial head, comparison of resection and internal fixation. J Bone Joint Surg Am.2005;87:76–84.
25. Ikeda M, Yamashina Y, Kamimoto M, et al. Open reduction and internal fixation of comminuted fractures of the radial head using low-profile miniplates. J Bone Joint Surg Br. 2003;85:1040–1044.
26. Janssen RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br. 1998;80:231–233.
27. King GJ, Evans DC, Kellarn JF. Open reduction and internal fixation of radial head fractures. J Orthop Trauma. 1991;5:21–28.
28.Knight DJ, Rymaszewski LA, Amis AA, et al. Primary replacement of the fractured radial head with metal prosthesis. J Bone Joint Surg Br. 1993;75:572–576.
29.Mancini GB, Fiacca C, Picuti G. Resection of the radial capitellum. Longterm results. Ital J Orthop Traumatol. 1989;15:295–302.
30.Struijs PA, Smit G, Steller EP. Radial head fractures: effectiveness of conservative treatment versus surgical intervention. A systematic review.Arch Orthop Trauma Surg. 2007;127:125–130.
31. Esser RD, Davis S, Taavao T. Fractures of the radial head treated by internal fixation: late results in 26 cases. J Orthop Trauma. 1995;9:318–323.
32. Pelto K, Hirvensalo E, Bostman O, et al. Treatment of radial head fractures with absorbable polyglycolide pins: a study on the security of the fixation in 38 cases. J Orthop Trauma. 1994;8:94–98.
33.RingD, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002;84:1811-1815.
34.Samuel A. Antu˜na, MD, PhD, FEBOT, Jos´e M. S´anchez-M´arquez, MD, and Ra ´ ul Barco, MD, FEBOT. Long-Term Results of Radial Head Resection Following Isolated Radial Head Fractures in Patients Younger Than Forty Years Old. J Bone Joint Surg Am. 2010;92:558-66.
35. Harrington IJ, Sekyi-Out A, Barrington TW, et al. The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long term review. J Trauma. 2001;50:46–52.
36.Herbertsson P, Josefsson PO, Hasserius R, et al. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004;86:1925–1930.
37.Judet T, Garreau DL, Piriou P, et al. A floating prosthesis for radial-head fractures. J Bone Joint Surg Br. 1996;78:244–249.
38.Judet T. Results of acute excision of the radial head in elbow radial head fracture–dislocations. J Orthop Trauma. 2001;15:308–309.
39. Moro JK, Werier J, MacDermid JC, et al. Arthroplasty with a metal radial head for unreconstructable fractures of the radial head. J Bone Joint Surg Am. 2001;83:1201–1211.
40.Sanders RA, French HG. Open reduction and internal fixation of comminuted radial head fractures. Am J Sports Med. 1986;14:130–135.
41.Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986;68:669-74.
42.O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the Elbow. J Bone Joint Surg Am. 1991;73:440-6.
43.Morrey BF, O’Driscoll SW. Lateral collateral ligament injury. In: Morrey BF, editor. The elbow and its disorders. 3rd ed. Philadelphia: WB Saunders; 2000;556-62.
44.Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 2nd ed. Philadelphia: WB Saunders; 1993;86-97.
45.Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases.Br J Surg. 1954 Sep;42(172):123-32.
46.Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of radial head and neck fractures. J Hand Surg Am. 2012 Jan;37(1):112-9. Epub 2011 Nov 25.
47.Michael Lapner, MD, BSc, FRCSC, and Graham J.W. King, MD, MSc, FRCSC. Radial Head Fractures. J Bone Joint Surg Am. 2013;95:1136-43.
48.Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004 Aug;86(8):1730-9.
49. Jensen SL, Olsen BS, Søjbjerg JO. Elbow joint kinematics after excision of the radial head. J Shoulder Elbow Surg. 1999 May Jun;8(3):238-41.
50. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004;86:1730-9. Faldini C, Pagkrati S, Grandi G, Digennaro V, Lauretani G, Faldini
51.Giannini S. What happens to the elbow joint after fractured radial head excision? Clinical and radiographic study at a mean 15-year follow-up. J Orthop Traumatol. 2006;7:126-30.
52.Goldberg I, Peylan J, Yosipovitch Z. Late results of excision of the radial head for an isolated closed fracture. J Bone Joint Surg Am. 1986;68:675-9.
53.Coleman DA, Blair WF, Shurr D. Resection of the radial head for fracture of the radial head. Long-term follow-up of seventeen cases. J Bone Joint Surg Am. 1987;69:385-92.
54.Miralles FA, Sebastia´c E, Cebria´cn R, Lizaur A. Resultados funcionales de las resecciones de la cabeza radial tras su fractura. Rev Ortop Traumatol. 2004;48:12-6.
55. Fuchs S, Chylarecki C. Do functional deficits result from radial head resection? J Shoulder Elbow Surg. 1999;8:247-51.
56.Janssen RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br. 1998;80: 231-3.
57.Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004;86:1925-30.
58. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg Am. 2005;87:76-84.
59. Morrey BF, Chao EY, Hui FC. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am. 1979;61:63-8.
60.Sowa DT, Hotchkiss RN, Weiland AJ. Symptomatic proximal translation of the radius f ollowing radial head resection. Clin Orthop Relat Res. 1995;317:106-13.
Published
2020-07-03
How to Cite
SPASOV, Marko et al.
RADIAL HEAD RESCTION - IS IT STILL VALUABLE SURGICAL SOLUTION?.
Journal of Morphological Sciences, [S.l.], v. 3, n. 1, p. 85-90, july 2020.
ISSN 2545-4706.
Available at: <http://jms.mk/jms/article/view/102>. Date accessed: 15 mar. 2025.
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