C Allavena1, S Delclaux1, N Bonnevialle1, M Rongières1, P Bonnevialle1, P Mansat2. 1. Service de chirurgie orthopédique-traumatologie, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex, France. 2. Service de chirurgie orthopédique-traumatologie, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex, France. Electronic address: mansat.p@chu-toulouse.fr.
Abstract
BACKGROUND: Radial head replacement is indicated to treat complex proximal radial fractures that are not amenable to internal fixation. HYPOTHESIS: Implantation of a bipolar radial head prosthesis after radial head excision ensures stability of the elbow and forearm, thereby promoting ligament healing and restoring elbow function. MATERIAL AND METHODS: Twenty-two patients managed with implantation of a bipolar radial head prosthesis (Guepar(®)) were evaluated after a mean follow-up of 50 months. The procedure was performed in the acute setting in 16 patients, including 13 with associated injuries; and at the stage of sequelae in 6 patients. RESULTS: Prosthesis removal was required in 4 patients. Of the remaining 18 patients, 14 (77%) had satisfactory Mayo Elbow Performance Score values, 14 (77%) little or no functional impairment, and 11 (61%) little or no pain. Mean motion arcs were 100° in flexion-extension and 143° in pronation-supination. Mean elbow strength in flexion and mean wrist strength were 67% and 86%, respectively, of those on the contralateral normal side. Radio-lucent lines were visible around the prosthesis in 5 patients, radial neck osteolysis in 10 patients, and capitellar erosion in 7 patients. Seven patients each experienced a complication. Early revision surgery to treat elbow instability was required in 6 patients. DISCUSSION: Outcomes after Guepar(®) bipolar radial head prosthesis implantation were disappointing in patients with complex radial head fractures seen in the acute or chronic setting. The associated injuries to bones and ligaments and the measures taken to repair them influence the prognosis. The complication rate is non-negligible and seems to increase over time. LEVEL OF EVIDENCE: IV, retrospective study.
BACKGROUND: Radial head replacement is indicated to treat complex proximal radial fractures that are not amenable to internal fixation. HYPOTHESIS: Implantation of a bipolar radial head prosthesis after radial head excision ensures stability of the elbow and forearm, thereby promoting ligament healing and restoring elbow function. MATERIAL AND METHODS: Twenty-two patients managed with implantation of a bipolar radial head prosthesis (Guepar(®)) were evaluated after a mean follow-up of 50 months. The procedure was performed in the acute setting in 16 patients, including 13 with associated injuries; and at the stage of sequelae in 6 patients. RESULTS: Prosthesis removal was required in 4 patients. Of the remaining 18 patients, 14 (77%) had satisfactory Mayo Elbow Performance Score values, 14 (77%) little or no functional impairment, and 11 (61%) little or no pain. Mean motion arcs were 100° in flexion-extension and 143° in pronation-supination. Mean elbow strength in flexion and mean wrist strength were 67% and 86%, respectively, of those on the contralateral normal side. Radio-lucent lines were visible around the prosthesis in 5 patients, radial neck osteolysis in 10 patients, and capitellar erosion in 7 patients. Seven patients each experienced a complication. Early revision surgery to treat elbow instability was required in 6 patients. DISCUSSION: Outcomes after Guepar(®) bipolar radial head prosthesis implantation were disappointing in patients with complex radial head fractures seen in the acute or chronic setting. The associated injuries to bones and ligaments and the measures taken to repair them influence the prognosis. The complication rate is non-negligible and seems to increase over time. LEVEL OF EVIDENCE: IV, retrospective study.
Authors: Pierre Laumonerie; Meagan E Tibbo; Panagiotis Kerezoudis; Marc Olivier Gauci; Nicolas Reina; Nicolas Bonnevialle; Pierre Mansat Journal: Int Orthop Date: 2018-07-30 Impact factor: 3.075
Authors: Pierre Laumonerie; Nicolas Reina; Claudia Gutierrez; Stephanie Delclaux; Meagan E Tibbo; Nicolas Bonnevialle; Pierre Mansat Journal: Int Orthop Date: 2017-09-21 Impact factor: 3.075
Authors: Pierre Laumonerie; Maroun Raad; Meagan E Tibbo; Panagiotis Kerezoudis; Nicolas Bonnevialle; Pierre Mansat Journal: Shoulder Elbow Date: 2019-05-19
Authors: Femke M A P Claessen; Rens Bexkens; I F Kodde; Job N Doornberg; Michel P J V D Bekerom; Denise Eygendaal Journal: Arch Bone Jt Surg Date: 2020-01