Fracture Pattern Influences Radial Head Replacement Size Determination Among Experienced Elbow Surgeons

Cucchi, Davide; Luceri, Francesco; Celli, Andrea; Menon, Alessandra; Barco, Raúl; Wegmann, Kilian; Randelli, Pietro; Eygendaal, Denise; Arrigoni, Paolo; Elbow, Esska

doi:10.1007/s43465-020-00039-0

Cited by 7 publications

(2 citation statements)

References 41 publications

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“…The coronoid process is the most important bony constraint against posterior elbow dislocation, together with the radial head [9][10][11][12][13]. With a loss of 50% or more of coronoid height, major translational, rotational and valgus-varus instability appears [14,15].…”

Section: Introductionmentioning

confidence: 99%

Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation

Luceri

Cucchi

Rosagrata

et al. 2021

JOIO

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Introduction Elbow bony stability relies primarily on the high anatomic congruency between the humeral trochlea and the ulnar greater sigmoid notch. No practical tools are available to distinguish different morphotypes of the proximal ulna and herewith predict elbow stability. The aim of this study was to assess inter-observer reproducibility, evaluate diagnostic performance and determine responsiveness to change after simulated coronoid process fracture for three novel elbow radiographic indexes. Methods Ten fresh-frozen cadaver specimens of upper limbs from human donors were available for this study. Three primary indexes were defined, as well as two derived angles: Trochlear Depth Index (TDI); Posterior Coverage Index (PCI); Anterior Coverage Index (ACI); radiographic coverage angle (RCA); olecranon–diaphisary angle (ODA). Each index was first measured on standardized lateral radiographs and subsequently by direct measurement after open dissection. Finally, a type II coronoid fracture (Regan and Morrey classification) was created on each specimen and both radiographic and open measurements were repeated. All measurements were conducted by two orthopaedic surgeons and two dedicated musculoskeletal radiologists. Results All three indexes showed good or moderate inter-observer reliability and moderate accuracy and precision when compared to the gold standard (open measurement). A significant change between the radiographic TDI and ACI before and after simulated coronoid fracture was observed [TDI: decrease from 0.45 ± 0.03 to 0.39 ± 0.08 (p = 0.035); ACI: decrease from 1.90 ± 0.17 to 1.58 ± 0.21 (p = 0.001)]. As expected, no significant changes were documented for the PCI. Based on these data, a predictive model was generated, able to identify coronoid fractures with a sensitivity of 80% and a specificity of 100%. Conclusion New, simple and easily reproducible radiological indexes to describe the congruency of the greater sigmoid notch have been proposed. TDI and ACI change significantly after a simulated coronoid fracture, indicating a good responsiveness of these parameters to a pathological condition. Furthermore, combining TDI and ACI in a regression model equation allowed to identify simulated fractures with high sensitivity and specificity. The newly proposed indexes are, therefore, promising tools to improve diagnostic accuracy of coronoid fractures and show potential to enhance perioperative diagnostic also in cases of elbow instability and stiffness. Level of evidence Basic science study. Clinical relevance The newly proposed indexes are promising tools to improve diagnostic accuracy of coronoid fractures as well as to enhance perioperative diagnostic for elbow instability and stiffness.

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Section: Introductionmentioning

confidence: 99%

Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation

Luceri

Cucchi

Rosagrata

et al. 2021

JOIO

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“…Among the bony constraints, the ulnohumeral joint plays a primary stabilizing role, whereas the radio-humeral joint has only a secondary function. The biomechanical role of the coronoid process, which acts mainly as anterior support against posterior displacement of the ulna and forearm, has been thoroughly studied [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Luceri

Cucchi

Rosagrata

et al. 2021

IJOO

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Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

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Radial head arthroplasty diameter impact on elbow kinematics evaluated by dynamic radiostereometric analysis

Teilmann,

Petersen,

Thillemann

et al. 2024

J. exp. orthop.

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PurposeRadial head arthroplasty (RHA) reestablishes elbow stability after complex radial head fracture, but complication rates are high, possibly due to inappropriate implant sizing. Knowledge of impact of radial head implant diameter on elbow kinematics is limited and warranted. This study evaluated elbow kinematics of different radial head implant diameters after RHA using dynamic radiostereometric analysis (dRSA).MethodsEight human donor arms were examined with dRSA during elbow flexion with the forearm in unloaded neutral position, and in supinated‐ and pronated position without and with 10N either varus or valgus load, respectively. Elbow kinematics were examined before and after RHA with head diameters of anatomical size, −2 mm (undersized), and +2 mm (oversized). The ligaments were kept intact by use of step‐cut humerus osteotomy for repeated RHA exchange. Bone models were obtained from CT, and by AutoRSA software bone models were matched with dRSA recordings. The elbow kinematics were described using anatomical coordinate systems.ResultsCompared to the native radial head during elbow flexion, the anatomical sized RHA shifted 2.0 mm in ulnar direction during unloaded pronated forearm position. The undersized RHA shifted 1.5 mm in posterior direction and 2.1 mm in ulnar direction during unloaded pronated forearm position and increased the varus angle by 2.4° during supinated loaded forearm position. The oversized RHA shifted 1.6 mm in radial direction during loaded supinated forearm position.ConclusionsThe anatomically sized RHA should be preferred as it maintained native elbow kinematics the best. The kinematic changes with oversized and undersized RHA diameters were small, suggesting forgiveness for the RHA diameter size.Level of EvidenceLevel III.

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Fracture Pattern Influences Radial Head Replacement Size Determination Among Experienced Elbow Surgeons

Cited by 7 publications

References 41 publications

Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation

Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation

Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Radial head arthroplasty diameter impact on elbow kinematics evaluated by dynamic radiostereometric analysis

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