Radial head arthroplasty using a metatarsal osteochondral autograft.
OBJECTIVE
Treatment of comminuted fractures of the radial head is controversial, and considerable effort has been made to restore optimal function of the elbows, either by surgical reconstruction or prosthetic replacement. This report presents our experiences in treatment of unreconstructable radial head or neck fractures using osteochondral autografts harvested from the base of the second metatarsal bones.


METHODS
Five patients with radial head and one with a radial neck fracture underwent treatment with osteochondral autografts. After excision of the unreconstructable radial head, the second metatarsal base was harvested and transplanted to the radius using the intramedullary nailing technique.


RESULTS
The reconstructed elbows were examined clinically and radiographically for a mean period of 44.8 months (range, 24-72 months). At the last follow-up, in flexion-extension, the mean elbow mobility was 130°/10°. In supination-pronation, the mean elbow mobility was 73.3°/66.7°, with a mean loss of supination of 19.2° and loss of pronation of 12.5°. Grip strength was 91%, compared with the contralateral limb. The mean Mayo Elbow Performance Score was 94.2. The mean score of AOFAS rating system to the lesser toe was 93.7 points.


CONCLUSIONS
Radial head arthroplasty with an osteochondral autograft from the second metatarsal base appears to be an effective alternative for treatment of unreconstructable radial head fractures. A larger group of patients and a longer follow-up period will be required in order to ease concerns regarding the donor site; however, none of the patients who underwent this procedure showed any complications during follow-up.
Department of Orthopaedic Surgery, Ajou University School of Medicine, Paldal-gu, Suwon City, South Korea.
Kyeong-Jin
KJ
Han
Kyung-Soo
KS
Oh
Nam-Su
NS
Chung
Yu Sang
YS
Lee
Sangjin
S
Youn
D000328:Adult; D057929:Arthroplasty, Replacement, Elbow / Q000295:instrumentation* / Q000379:methods*; D001858:Bone Nails; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008684:Metatarsus / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome