Radial head replacement versus reconstruction for the treatment of the terrible triad injury of the elbow: a systematic review and meta-analysis

Abstract

IntroductionThe terrible triad injury of the elbow (TTIE) remains challenging to manage and has been associated with high complication rates and poor outcomes. There is a trend towards performing radial head replacement (REP) in preference to radial head reconstruction (REC) as arthroplasty provides early stability and may allow mobilisation sooner, potentially resulting in a better functional outcome. This systematic review compares the outcome of patients with TTIE treated with either REC or REP.Materials and methodsMEDLINE, Embase, and CINAHL were searched for studies published in English involving at least ten patients exclusively with a TTIE managed operatively, including both patients with either REC or REP. Data collection was in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis protocol. The outcomes of interest were Mayo Elbow Performance Score (MEPS) and range of motion (ROM). Post-operative complications were also compared.Results9 studies involving 210 patients were included (98 REPs and 112 RECs). There was no statistically significant difference (p = 0.51) demonstrated between in the mean MEPS of the REP group (mean 88.6) and REC group (mean 88.5). Similarly, there was no statistically significant difference demonstrated between the REP and REC groups in terms of ROM. The risk of re-operation was high in both the REP (18.4%) and REC (17.9%) group. The overall complication rate of all patients included in the study was high (65%).ConclusionsComparable results with good outcomes in terms of functional scores and ROM can be achieved with both REP and REC when treating TTIE, although the re-operation rate for both remains relatively high. Given there is no apparent clear advantage between the two treatment groups, we would suggest that REC should be performed when a satisfactory fixation can be achieved as the longevity of REP in young patients with a TTIE is currently uncertain.

Patient and Surgeon Factors Associated With Prosthetic Replacement Rather Than With Open Reduction and Internal Fixation of a Radial Head Fracture

“…Current evidence demonstrates variations in treatment protocol, with some surgeons reserving radial head ORIF for minimally comminuted fractures with 3 or fewer articular fragments, whereas others perform fixation whenever it is technically possible. [10][11][12]17,18 The area of the radial head that is injured can be larger than what is initially identified on imaging studies. 19,20 Results on fixation of unstable, displaced, comminuted fractures of the radial head have demonstrated poor outcomes with early failure, nonunion, and poor forearm rotation.…”

“…19,20 Results on fixation of unstable, displaced, comminuted fractures of the radial head have demonstrated poor outcomes with early failure, nonunion, and poor forearm rotation. 6,[17][18][19] In comminuted radial head fractures, the outcomes of ORIF are less than optimal. A radial head arthroplasty is a reasonable option in cases of significant comminution with patients having satisfactory stability and functional outcomes.…”

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

“…Unfortunately, elbow stiffness is still a common complication, which severely decreases the patients' quality of life [21][22][23]. Many factors may in uence the treatment results of TTI, including the fracture type of radial head and coronoid process, the surgical incision, the time between injury and surgery and the degree of ligament injury [24][25][26][27]. Identifying the potential risk factors for elbow stiffness after surgery treatment of TTI may assist surgeons taking preventive measures and improving the treatment of theses serious injuries, but there have been little studies published so far.…”

Functional Outcomes of Unstable Traumatic Elbow Injuries: How and When to Fix Them

“…Fixing the radial head in terrible triad injuries is straight forward in the literature recommendations. If the radial head is comminuted, the treatment is based on the size of the fragments [31,32]. If there are multiple large fragments that can be reduced and fixated internally then it is best to do so [33].…”