Detrimental Effects of Overstuffing or Understuffing With a Radial Head Replacement in the Medial Collateral-Ligament Deficient Elbow

Glabbeek, Francis Van; Riet, Roger P. van; Baumfeld, Joshua A.; Neale, Patricia G.; O’Driscoll, Shawn W.; Morrey, B.F.; An, Kai Nan

doi:10.2106/00004623-200412000-00007

Cited by 219 publications

(93 citation statements)

References 18 publications

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“…Sizing is often performed with the elbow in extension, but the radiocapitellar joint is tighter in flexion than extension, which can lead to overstuffing [1]. Van Glabbeek et al [23] also showed how overstuffing the radiocapitellar joint by even 2.5 mm resulted in increased joint pressures. Frank et al [6] reported that intraoperative visualization of a gap in the medial ulnohumeral joint may indicate overstuffing.…”

Section: Discussionmentioning

confidence: 99%

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Watters

Garrigues

Ring

et al. 2014

Clinical Orthopaedics &Amp; Related Research

111

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Background Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. Specifically, the question of whether to repair or replace the radial head remains controversial. Questions/purposes We compared patients with terrible triad injuries of the elbow whose radial head fracture was treated with either internal fixation and internal fixation (ORIF) or radial head arthroplasty in terms of (1) clinical outcome measures (DASH and Broberg-Morrey scores, ROM), (2) elbow stability and radiographic signs of arthrosis, and (3) complications and reoperation rates. Methods Retrospective review identified 39 patients with terrible triad injuries and minimum 18-month complete clinical and radiographic followup (mean, 24 months; range, 18-53 months). Patients were managed with a standard algorithm consisting of (1) repair (n = 9) or replacement (n = 30) of the radial head, (2) repair of the lateral ulnar collateral ligament, and (3) repair of the coronoid fracture. During the study period, the radial head generally was internally fixed when there were fewer than four articular fragments; otherwise, it was replaced. Evaluation included the DASH score, the Broberg-Morrey index, measurements of elbow stability and motion, and radiographic assessment for signs of arthrosis; chart review was performed for complications and reoperations. Complete followup was available on 87% (39 of 45 patients).

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Section: Discussionmentioning

confidence: 99%

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Watters

Garrigues

Ring

et al. 2014

Clinical Orthopaedics &Amp; Related Research

111

View full text Add to dashboard Cite

show abstract

“…Regardless of design, recent literature has favored metal prostheses [1,24,30,36,37] despite evidence of altered joint contact pressures in radiocapitellar articulations involving metallic implants [18]. ''Overstuffing'' as a result of an excessively large prosthesis has received considerable attention [4,40] and problems of persistent pain and radiographic evidence of arthritis ( Fig. 1A-B) are becoming apparent, suggesting, like other metal-oncartilage interfaces, metal hemiarthroplasty may not be an ideal solution (Fig.…”

Section: Introductionmentioning

confidence: 99%

Is a Silastic Radial Head Still a Reasonable Option?

Maghen

Leo

Hsu

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of ''overstuffing,'' cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial. Questions/purposes We asked whether intact or reconstructed primary elbow stabilizers permit use of silastic radial head implants without fragmentation, failure, and silicone synovitis. Methods We retrospectively reviewed 23 patients with unreconstructable radial head fractures who were treated with silastic radial head arthroplasty and concomitant repair and/or reconstruction of the medial ulnar collateral ligament and/or lateral ulnar collateral ligament. Analysis included range of motion, pain, stability, and radiographic assessments; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; and Mayo Elbow Performance Score (MEPS). The minimum followup was 16 months (average, 69.6 months; range, 16-165 months). Results At last followup, the mean elbow flexion was 145°, extension 11°, supination 80°, and pronation 83°. The mean MEPS score was 88.9. The mean DASH score was 11.8. There were eight reoperations, none resulting from failure of the radial head implants. Conclusions These results demonstrate silastic radial heads can be used with low complication rates and without evidence of synovitis when concomitant elbow ligament repair or reconstruction is performed.

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“…Una de las principales y que tiene una repercusión inmediata en la función articular es la colocación de un implante demasiado grande. Este problema conocido en la literatura como overstuffing, puede ocasionar distintos inconvenientes, como la subluxación del codo y fenómenos de erosión capitelar con dolor y limitación en la movilidad 29 (Fig. 3).…”

Section: Discussionunclassified

Prótesis de cúpula monopolar en el tratamiento de fracturas y luxofracturas del radio

Gallucci¹,

Pereira²,

Boretto³

et al. 2014

Rev. Asoc. Arg. Ort. y Traumatol

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Re ci bi do el 2-10-2012. Acep ta do lue go de la eva lua ción el 14-11-2013. Co rres pon den cia:Dr. GERARDO GALLUCCI gerardo.gallucci@hospitalitaliano.orgRe su men Objetivo: Evaluar retrospectivamente los resultados clínicos y radiológicos de una serie consecutiva de pacientes con fracturas y luxofracturas de la cúpula radial a quienes se les realizó el reemplazo por una prótesis monopolar. MaterialesyMétodos: Se incluyeron 20 pacientes. Criterios de inclusión: <18 años, con fracturas o luxofracturas de la cúpula radial, tratados con prótesis monoblock de titanio y seguimiento mínimo de un año. Quince eran mujeres, edad promedio 59 años. Siete eran fracturas aisladas y 13, luxofracturas. Se evaluaron el grado de aflojamiento protésico, la erosión capitelar, el ensanchamiento del espacio articular humeral lateral y las calcificaciones heterotópicas. El seguimiento fue de 26 meses. Resultados: La flexo-extensión fue de 139º-5º y la pronosupinación, de 79-79°. El arco total fue de 134°. Fuerza de puño: 84% del lado contralateral. El dolor según la escala analógica visual fue de 2, DASH: 11 puntos, 13 resultados excelentes y 6 buenos. Se detectó aflojamiento del implante (12 casos), aumento de la radiolucidez capitelar (4 casos) y ensanchamiento del espacio ulnohumeral lateral (2 casos). Hubo 2 complicaciones: una neurodocitis cubital que debió ser operada y una extracción de implante por aflojamiento y dolor. Conclusiones: El reemplazo de la cúpula radial en lesiones no reconstruibles es una opción terapéutica viable, con buenos resultados funcionales a corto y mediano plazo. La recuperación de la estabilidad articular fue posible en todos los casos y el índice de aflojamiento protésico asintomático fue elevado.Palabrasclave: Cúpularadial.Prótesisdecúpula. Fracturaderadio.Luxofracturaderadio. Monopolarradialheadarthroplasty inthetreatmentoffractureandfracturedislocationsoftheradiusAbstract Objective: To retrospectively evaluate the clinical and radiological results of a consecutive series of patients with fracture and fracture-dislocations of the radius, treated with a monopolar radial head arthroplasty. Methods: Twenty patients were included. Inclusion criteria: <18 years old, with fracture and fracture-dislocations of the radius, treated with a titanium monopolar radial head arthroplasty and a minimun follow-up of one year. Fifteen were female, average age of 59 years old. Seven were isolated radial head fractures and 13 were fracturedislocations. Loosening of the implant, capitelar erosion, overstuffing and heterotopic ossification were evaluated. Average follow-up was 26 months. Results: Flexo-extension was 139°-5° and prono-supination 79°-79°. Total arc of motion was 134°. Grip strength was 84% of the contralateral side. Pain according to a visual analogue scale was 2, DASH: 11 points. Thirteen patients had excellent results and 6 good. Loosening of the implant (12 patients), capitelar erosion (4 patients) and overstuffing (2 patients) were detected. One patient had an ulnar neuropathy and he was operated on...

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Detrimental Effects of Overstuffing or Understuffing With a Radial Head Replacement in the Medial Collateral-Ligament Deficient Elbow

Cited by 219 publications

References 18 publications

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Is a Silastic Radial Head Still a Reasonable Option?

Prótesis de cúpula monopolar en el tratamiento de fracturas y luxofracturas del radio

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