Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

  • Yang, Hee Seok (Department of Orthopaedic Surgery, Wonkwang University Hospital) ;
  • Kim, Jeong Woo (Department of Orthopaedic Surgery, Wonkwang University Hospital) ;
  • Lee, Sung Hyun (Department of Orthopaedic Surgery, Wonkwang University Hospital) ;
  • Yoo, Byung Min (Department of Orthopaedic Surgery, Wonkwang University Hospital)
  • Received : 2018.09.07
  • Accepted : 2018.10.11
  • Published : 2018.12.01
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Abstract

Background: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved <50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation. Methods: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving <50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. Results: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. Conclusions: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving <50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

Keywords

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Fig. 1. Arthroscopic findings (A) and preoperative three-dimensional computed tomography image (B) of comminuted radial head fracture.

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Fig. 2. Arthroscopic view (A) and anteroposterior radiography (B) of radial head fracture after excision of fracture fragment.

Table 1. Data of the Patients Who Underwent Arthroscopic Treatment for Radial Head Fracture with Elbow Fracture-dislocation

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Table 2. Comparison of Clinical Outcomes between the Two Groups

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