Management of comminuted fracture of radial head by radial head excision and anconeus arthroplasty

Author(s): Dr. Abhijit M. Kadam, Dr. Anil Khandekar, Dr. Nagesh Naik, Dr. Sunil Patil and Dr. Shrikant Deshpande

Abstract: Background: Fracture and dislocation of radial head commonly occur secondary to trauma, usually from fall on the outstretched hand. These fractures are notorious for development of complications which include stiffness, arthritis, radial nerve injury and deformities. The patient usually presents with the history of fall on outstretched hand followed by pain and swelling around wrist. The types of fractures which may occur include non-displaced isolated radial head fracture, single fragment displaced and comminuted fractures. For comminuted fractures the treatment options include screw fixation of individual fragments or radial head excision in irreparable cases. Excision of radial head is associated with altered elbow kinematics and increased laxity. Management of comminuted radial head fracture by radial head resection along with anconeus interposition arthroplasty had been described by few authors. We conducted this study to know the outcome of patients who were treated by radial head resection along with anconeus interposition arthroplasty following irreparable comminuted radial head fracture. Aims and Objectives: The purpose of this study was to know the outcome of radial head resection with anconeus interposition arthroplasty and complications associated with this procedure in patients of irreparable comminuted fracture of radial head. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 30 patients who had been admitted to our institute with the diagnosis of comminuted fracture of radial head. Patients were enrolled on the basis of pre-defined inclusion criteria and any patient having any exclusion criteria was excluded from the study. X-Ray, 3 D CT and MRI (if required) were done. Detailed history, thorough clinical examination and baseline investigations were done. All patients underwent radial head resection with anconeus interposition arthroplasty. The outcome of procedure and associated complications were studied. The data was tabulated and analyzed using SPSS 16.0 version software. Results: Out of 30 studied cases 18 (60%) were males and 12 (40%) were females with M:F ratio of 1: 0.66. Predominantly fractures were seen on right side (66.66 %). All patients underwent radial head resection with anconeus interposition arthroplasty. Majority of the patients (90%) were found to have either excellent or good outcome. the Mayo Elbow Performance Score (MEPS) was found to have improved statistically significantly. Quick Disabilities of Arm, Shoulder and Hand (Quick DASH) score was also found to have improved in all the patients and majority of the patients had either no or mild difficulty with a mean Quick Dash Score of 22. The complications in the studied cases included wound infection (6.66%), hematoma (6.66%) and nerve injury (3.33% patients). On long term follow up 5 (16.66%) patients were found to have developed arthritis of elbow joint, repeat surgeries were required in 3 (10%) patients and 1 (3.33%) patient developed valgus deformity of the elbow joint. Conclusion: Radial head excision with anconeus interposition arthroplasty is found to have good to excellent results in patients with type III radial head fractures. The complications following this procedure can be managed conservatively in almost all the patients.

DOI: https://doi.org/10.22271/ortho.2018.v4.i1e.44