title: Radial head prosthesis in complex elbow dislocations: effect of oversizing and comparison with ORIF.
abstract: OBJECTIVE
  Elbow dislocations with complex elbow instability (CEI) and unstable radial head fractures require reconstruction by open reduction and internal fixation (ORIF) if possible or alternatively by a radial head prosthesis. The aim of this study was to determine the differential outcome of both strategies and to investigate the contribution of prosthesis-related radiographic factors such as oversizing on clinical outcome.
  
  
  METHODS
  A total of 53 patients underwent ligament and coronoid refixation, and radial head reconstruction by ORIF (n = 18; group 1) or by monopolar modular prosthesis (n = 35; group 2). Patients were followed by the Mayo Elbow Performance Score (MEPS) and a radiological score including prosthesis oversizing, joint subluxation, ossifications, capitellar erosions, implant loosening and ulno-humeral osteoarthritis. To investigate the effect of oversizing, group 2 was subdivided by prosthesis overlenghtening ≥ 2 mm.
  
  
  RESULTS
  A total of 42 patients (79.2%) could be followed for 3.0 ± 1.3 years with an average MEPS of 76.8 ± 17.2. Patients with ORIF had slightly better MEPS (82.1 ± 9.9) as compared with group 2 (74.7 ± 19.1) though three ORIF patients required an early conversion to prosthesis. In group 2, oversizing occurred frequently and 50% showed an overlenghtening ≥ 2 mm. Oversizing significantly decreased MEPS (63.2 ± 21.3 vs 84.7 ± 9.0; p = 0.001) and elbow range of motion and increased the occurrence of other radiological abnormalities and the risk for surgical revisions. The radiological score and prosthesis overlenghtening but not prosthesis diameter showed an inverse correlation with MEPS.
  
  
  CONCLUSIONS
  In CEI a radial head reconstruction with a prosthesis demonstrates similarly good clinical results as compared to ORIF in anatomically sized prosthesis, but prosthesis oversizing could induce other radiographic abnormalities with then deteriorated outcome.
authors.affiliation: Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Abteilung für Unfallchirurgie und Orthopädie, Ludwig Guttmann Strasse 13, 67071, Ludwigshafen on the Rhine, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schnetzke
authors.forename: Sara
authors.initials: S
authors.lastname: Aytac
authors.forename: Moritz
authors.initials: M
authors.lastname: Deuss
authors.forename: Stefan
authors.initials: S
authors.lastname: Studier-Fischer
authors.forename: Benedict
authors.initials: B
authors.lastname: Swartman
authors.forename: Matthias
authors.initials: M
authors.lastname: Muenzberg
authors.forename: Paul-Alfred
authors.initials: PA
authors.lastname: Gruetzner
authors.forename: Thorsten
authors.initials: T
authors.lastname: Guehring
mesh_terms: D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D058569:Elbow Prosthesis; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017755:Prosthesis Fitting; D019919:Prosthesis Implantation; D011859:Radiography; D011885:Radius Fractures / Q000150:complications* / Q000601:surgery*; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D000092464:Elbow Injuries
references.citation: Unfallchirurg. 2009 May;112(5):506-12
references.pmid: 19440646
references.citation: AJR Am J Roentgenol. 2012 Nov;199(5):1078-82
references.pmid: 23096182
references.citation: Unfallchirurg. 2008 Dec;111(12):997-1004
references.pmid: 19039568
references.citation: Injury. 2008 Dec;39(12):1329-37
references.pmid: 18703190
references.citation: J Orthop Trauma. 1991;5(1):21-8
references.pmid: 2023039
references.citation: Instr Course Lect. 1998;47:157-64
references.pmid: 9571413
references.citation: J Bone Joint Surg Am. 2010 Sep;92 Suppl 1 Pt 2:250-7
references.pmid: 20844180
references.citation: Clin Orthop Relat Res. 2014 Jul;472(7):2128-35
references.pmid: 24136807
references.citation: J Bone Joint Surg Am. 2004 May;86(5):975-82
references.pmid: 15118040
references.citation: Med Eng Phys. 2005 May;27(4):336-42
references.pmid: 15823475
references.citation: Int Orthop. 2013 Apr;37(4):631-9
references.pmid: 23271690
references.citation: J Bone Joint Surg Am. 1987 Apr;69(4):605-8
references.pmid: 3571318
references.citation: J Shoulder Elbow Surg. 2013 Oct;22(10):1395-9
references.pmid: 23790674
references.citation: Clin Orthop Relat Res. 1992 Feb;(275):79-84
references.pmid: 1735237
references.citation: J Bone Joint Surg Am. 2004 May;86(5):1061-4
references.pmid: 15118054
references.citation: J Bone Joint Surg Br. 2009 Nov;91(11):1499-504
references.pmid: 19880897
references.citation: Bone Joint J. 2013 Oct;95-B(10):1383-7
references.pmid: 24078536
references.citation: Radiographics. 2012 Jan-Feb;32(1):129-49
references.pmid: 22236898
references.citation: Ulster Med J. 1962 Jun 1;31:51-6
references.pmid: 14452145
references.citation: J Bone Joint Surg Am. 1989 Oct;71(9):1348-54
references.pmid: 2793888
references.citation: Clin Orthop Relat Res. 2014 Jul;472(7):2120-7
references.pmid: 24585322
references.citation: J Bone Joint Surg Br. 1998 Nov;80(6):1031-6
references.pmid: 9853498
references.citation: J Shoulder Elbow Surg. 2012 Oct;21(10):1336-41
references.pmid: 22705316