title: Radial Head Fractures Treated with Modular Metallic Radial Head Replacement: Outcomes at a Mean Follow-up of Eight Years.
abstract: BACKGROUND
  Radial head arthroplasty is commonly used to treat acute unreconstructible radial head fractures. The purpose of this study was to report on the clinical and radiographic outcomes at a minimum follow-up of five years after radial head arthroplasty with a modular metallic implant for the treatment of acute radial head fractures.
  
  
  METHODS
  The cases of fifty-five patients with unreconstructible radial head fractures treated acutely with a smooth-stemmed modular metallic radial head implant were retrospectively reviewed. A wide variety of injuries, which ranged from isolated radial head fractures to so-called terrible triad injuries, were included. All patients returned for an interview, physical examination, and radiographic evaluation at a mean of eight years (range, five to fourteen years) postoperatively. Elbow and forearm motion, elbow strength, and grip strength were measured. Radiographs were evaluated, and validated patient-rated outcome questionnaires were completed. A longitudinal subgroup analysis was performed for thirty-three patients who were previously evaluated at two years postoperatively.
  
  
  RESULTS
  At a mean of 8.2 ± 2.9 years, the mean arc of flexion (and standard deviation) of the affected elbow was 11° ± 14° to 137° ± 15°. Elbow strength and motion were significantly diminished compared with the unaffected elbow (p < 0.05). The mean Mayo Elbow Performance Index (MEPI) was 91 ± 13 points. Twenty-five patients (45%) had stem lucencies; twenty-one (38%), ulnohumeral arthritis; and twenty (36%), heterotopic ossification, including one with radioulnar synostosis. Two patients underwent secondary elbow surgery, but no patient required implant removal or revision. In the subgroup evaluated longitudinally, there was a significant improvement in MEPI scores from the two-year to the eight-year follow-up (p = 0.012), with no loss of motion or strength (p > 0.05).
  
  
  CONCLUSIONS
  The mid-term outcomes of radial head arthroplasty with a smooth-stemmed modular metallic prosthesis are comparable with previously reported short-term outcomes, with no evidence of functional deterioration. Radial head arthroplasty with a smooth-stemmed metallic modular implant is a good treatment option for patients with acute unreconstructible radial head fractures, and sustained clinical outcomes may be expected beyond five years of follow-up.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Pan Am Clinic, Winnipeg, Manitoba, Canada.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Marsh
authors.affiliation: Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
authors.forename: Ruby
authors.initials: R
authors.lastname: Grewal
authors.affiliation: Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Faber
authors.affiliation: Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
authors.forename: Darren S
authors.initials: DS
authors.lastname: Drosdowech
authors.affiliation: Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
authors.forename: George S
authors.initials: GS
authors.lastname: Athwal
authors.affiliation: Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada gking@uwo.ca.
authors.forename: Graham J W
authors.initials: GJ
authors.lastname: King
mesh_terms: D019643:Arthroplasty, Replacement; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome