Radial Head Resection and Corium Interposition Arthroplasty in Skeletally Immature Patients With Isolated Posttraumatic Radial Head Arthrosis

Abstract

Radiocapitellar arthrosis represents a serious sequela of pediatric elbow injuries. Although persistent pain and disability are not uncommon in such cases, treatment remains controversial. The present study aimed to review the clinical outcomes after a new surgical treatment with partial radial head resection and corium interposition arthroplasty. To date, 3 adolescent cases underwent the surgical procedure and postoperative care. Thorough clinical and radiographic follow-up was performed. The mean age at the time of surgery was 14.4 years (range, 13 to 16 y) and mean duration of follow-up was 19 months (range, 12 to 29 mo). The postoperative range of motion was maintained in all cases. The outcome was rated as excellent in all 3 patients for the Disabilities of the Arm, Shoulder and Hand score (mean, 3; range, 0 to 6.7) and Mayo Elbow Performance Score (mean, 92; range, 80 to 100). The mean Timmermann score; however, was still rated as fair despite marked improvements (mean, 153; range, 145 to 165). No complications such as elbow stiffness, osteophytes formation, radial head overgrowth, or proximal radius migration occurred. In pediatric isolated posttraumatic radiocapitellar arthrosis, we believe that radial head resection and corium interposition arthroplasty is an effective salvage procedure to alleviate symptoms and maintain elbow function with good to excellent clinical outcomes and no proximal migration of the radius.

A salvage procedure: Radial head excision in children and adolescents—short-to-midterm outcomes and overview of the literature

“…Some authors have mentioned radial head resection as a salvage procedure for post-traumatic disorders at the proximal radius ( Table 5 ). 4 , 6 , 7 , 10 , 27 , 28 , 32 Weise et al 33 mentioned radial head resection if functional impairment and pain persist after radial head fracture after skeletal maturity.…”

“…No proximal migration of the radius had occurred at the final follow-up after 19 months. 32 Factor et al reported four patients (one congenital, three post-traumatic) after radial head excision followed by Achilles allograft interposition arthroplasty with averaged MEPS of 92.5 and improved ROM at 2 years follow-up. In all patients, proximal migration of the radius occurred despite the allograft interposition.…”

Autologous replacement of the head of the radius—proximal fibula versus second metatarsal base: an anatomic feasibility study

“…To compensate for the suboptimal fit of the second metatarsal base to the radial notch of the ulna, an additional anconeus interposition ( 49 ), Achilles tendon interposition ( 9 ) or corium interposition ( 11 ) could be options to optimize the radioulnar movability. Alternatively, a costochondral graft has been described especially for bone replacement in children.…”

“…The latter may cause a vicious circle of consecutive ulnocarpal impaction syndrome with a need of ulnar shortening procedures due to the proximal radial migration ( 14 ). To prevent such occurrence, multiple interposition arthroplasty techniques have already been described for the pediatric population ( 9 , 11 ).…”

Treatment of advanced stage osteochondrosis dissecans in the adolescent elbow using a hyaloronic acid-based scaffold: a case series of 5 patients

“…The surgical approach is similar to the one described previously [ 33 ]. Briefly, a lateral Kocher approach to the elbow patient is performed with the patient lying in the supine position (Fig.…”