Search Results (29)

A traumatic elbow dislocation that remains unreduced for more than three weeks is considered a neglected elbow dislocation. We report a case of a patient with a neglected elbow dislocation combined with a terrible triad injury (elbow dislocation with fractures of the coronoid process and radial head). Initially, the patient was managed with three weeks of cast immobilization followed by physiotherapy. However, six months after the trauma, he presented to our clinic with severe heterotopic ossification, significant pain, and nearly complete elbow stiffness. An open surgical intervention was performed, involving excision of the heterotopic bone, reduction in the dislocation, and suturing of the anterior capsule to the coronoid process. Given the irreparable fracture of the radial head, radial head arthroplasty was also performed. At 18-month follow-up, the elbow was stable and pain-free, with flexion–extension of 80°, pronation of 85°, and supination of 80°. This case underscores the critical importance of early diagnosis and intervention to prevent long-term complications in neglected elbow dislocations. Full article

Introduction: Various classifications of radial head fractures have been reported in the literature, most of them are based solely on conventional radiographic criteria. The Mason–Johnston classification, currently the most widely used system worldwide, is affected by the limitations of conventional radiographs. The aim of our study is to confirm or refute the low reliability and reproducibility of the Mason–Johnston classification. Materials and Methods: The study collected elbow X-rays showing radial head fractures from 2011 to 2021. Images were evaluated by eight orthopedic surgeons and one radiologist consultant from different hospitals for classification. The first phase assessed inter-observer agreement, comparing classifications among participants. After four months, the same images were randomly reordered and then reclassified to evaluate intra-observer agreement. A total of 90 elbow X-rays from 50 women and 40 men were analyzed. Inter- and intra-observer agreement was assessed using Fleiss’ kappa, Krippendorff alpha, and Cohen’s kappa. Results: Overall inter-observer agreement by unweighted Fleiss’ κ was moderate in both sessions (κ = 0.49 and κ = 0.50), with overall pairwise percent agreement 63% and prevalence- and bias-adjusted κ (PABAK, k = 4) ≈ 0.50. As an ordinal sensitivity analysis, Krippendorff’s α (ordinal) was 0.726 and 0.744, indicating substantial agreement. Type-specific reliability was moderate for Types II–III and higher for Type IV. Unweighted Cohen’s kappa coefficients were calculated to assess intra-observer agreement, demonstrating moderate to substantial levels of concordance. Conclusions: The Mason–Johnston classification shows moderate inter-observer reliability, especially for Types II–III, and moderate to substantial intra-observer agreement. Full article

Objective: There is scarce reporting of radial head fracture epidemiology and patient characteristics beyond age and sex. This study aimed to describe demographic, socioeconomic, and injury pattern characteristics for people sustaining a radial head fracture admitted to trauma centers over a 15-year period. Methods: Analysis of Victorian Orthopaedic Trauma Outcomes Registry data was conducted to describe the demographic and case characteristics of patients with radial head fractures admitted to collaborating hospitals. Cohort and case characteristics were compared by center type (Level 1 vs. other trauma centers). Results: A total of 991 cases with a unilateral radial head fracture were recorded over 15 years, with 827 admitted to Level 1 trauma centers and 164 admitted to other centers. The mean age at time of injury was 48.7 years (SD 19.7), with male predominance (n = 621, 62.7%). Most patients resided in major cities (n = 824, 85.2%), were treated under the universal healthcare system (n = 546, 56.1%), and had no Charlson Comorbidity Index conditions (n = 738, 74.5%). A higher proportion of patients managed at Level 1 centers were male (65.7% vs. 47.6%), younger (mean 47.7 vs. 53.7 years), living in major cities (86.6% vs. 78.5%), and working prior to injury (71.3% vs. 57.1%). Over 85% of the cohort sustained concomitant injuries, with Level 1 centers receiving a higher proportion of multiple injury cases (87.8% vs. 73.2%). Elbow dislocations constituted the largest proportion of concomitant injuries (n = 257, 25.9%). Conclusions: This study has provided new insights into the demographic characteristics, comorbidity status, and associated injuries of radial head fracture populations admitted to Level 1 and other trauma centers, using long-established registry data. Full article

Background/Objectives: Radial head arthroplasty (RHA) and open reduction and internal fixation (ORIF) have emerged as predominant methods of surgical management for radial head fractures. The objective of this study was to evaluate national trends in management of radial head fractures among ABOS oral examination candidates and to compare complication rates between RHA and ORIF. Methods: A search of the American Board of Orthopaedic Surgery (ABOS) oral examination database identified radial head fractures treated with RHA or ORIF between 2003 and 2021 in patients 18 years or older. Results: RHA cases increased significantly from 2003–2021 (p < 0.001). Patients undergoing RHA were older (52.4 years vs. 42.9 years, p < 0.001) and predominantly female (60.8% vs. 45.7%, p < 0.001). Medical and surgical complications within 60 days were higher after RHA (2.9% vs. 1.6%, p = 0.012; 24.9% vs. 20.4%, p = 0.001), most commonly stiffness (10.8% vs. 7.1%, p < 0.001), nerve injury (3.3% vs. 2.7%, p = 0.26), and implant failure (3.4% vs. 2.4%, p = 0.064). Non-union or delayed union (0.5% vs. 2.5%, p < 0.001) was significantly higher after ORIF, and fracture (1.1% vs. 0.3%, p = 0.008) was significantly higher after RHA. The highest proportion of RHA to ORIF was performed by surgeons with shoulder and elbow fellowship training (p < 0.001). Conclusions: Among ABOS Candidates, RHA volume surpassed ORIF for radial head fractures in 2010. Surgical complication rates for radial head fractures are high at 60 days follow-up for both procedures. RHA is associated with higher complication rates, especially stiffness; however, similar reoperation and readmission rates suggest that RHA may have been selected for more complex injuries. Full article

Reliable estimates of aquifer properties are needed for groundwater resources management and for engineering applications. Pumping tests conducted in fractured aquifers using an open borehole may not produce a proper characterization of the aquifer properties leading to the failure of engineering solutions. In this work, we apply a radial flow model to reproduce the time drawdown curves recorded at an observation borehole instrumented with multi-level piezometers drilled in the Permo-Triassic sandstone, which is a complex fractured hydraulic unit. The radial flow model and the optimization code PEST are used to estimate the aquifer hydraulic parameter values. The model is then used to investigate the implications of replacing the multi-level piezometers with an open borehole. The results show that the open borehole does not only significantly alter the groundwater head and flow patterns around the borehole, but the analysis of the time drawdown curve obtained would produce estimates of aquifer properties that bear no relationship with the actual hydraulic properties of the aquifer. For engineering control studies, the pumping test must be carefully designed to account for the presence of fractures, and these must be represented in the analysis tools to ensure the correct characterization of the hydraulic system. Full article

Background/Objectives: Radial head arthroplasty is a commonly preferred treatment for complex, unreconstructable radial head fractures. Recent studies have raised the question of whether factors such as bone resorption may be related to failure. This observational, retrospective, multicenter, spontaneous, and non-profit study aims to assess radiological outcomes, focusing on bone resorption around the stem, for radial head replacement using a modular, cementless radial head prosthesis with interconnected porosity. Methods: A series of 42 cases was available for review. Patients underwent radial head arthroplasty using a three-dimensional-printed radial head prosthesis. Patients were eligible for inclusion if they had undergone at least one follow-up between 6 and 15 months post-operatively. A scoring system to detect bone resorption was developed and administered by two independent evaluators. Results: Forty-two patients (14 males, 28 females), with an average age of 59 ± 11 years (range: 39–80 years), were analyzed with a minimum of six months’ and a maximum of 32 months’ follow-up. At follow-up, 50 radiological evaluations were collected, with 29 showing ≤3 mm and 12 showing 3–6 mm resorption around the stem. The average resorption was 3.5 mm ± 2.3. No correlation was found between the extent of resorption and the time of follow-up. The developed scoring system allowed for a high level of correlation between the evaluators’ measurements of bone resorption. Conclusions: Radial head prosthesis with interconnected porosity provided a low stem resorption rate for patients after a radial head fracture at short-to-mid-term follow-up after the definition of a reliable and easy-to-use radiological-based classification approach. (Level of Evidence: Level IV). Full article

Introduction: Monteggia fractures, first described by Giovanni Battista Monteggia, involve a fracture of the proximal ulna with anterior dislocation of the radial head. Bado’s 1967 classification divides these injuries into four types. Rare mixed patterns exist, overlapping with other forearm injuries such as Galeazzi and Essex–Lopresti lesions. These complex fractures/dislocations pose significant diagnostic and therapeutic challenges and are not adequately represented in current classification systems. Methods and Case Presentation: We report the case of a 56-year-old woman with a complex forearm injury sustained from a fall, presenting with radial head fracture/dislocation, mid-shaft radial fracture, distal ulna fracture, and ulnar collateral ligament rupture. Intraoperative imaging confirmed DRUJ stability and partial interosseous membrane disruption. Surgical management included radial head prosthesis implantation, radial shaft fixation with an anatomical locking plate, intramedullary nailing of the distal ulna, and ligament reconstruction. At two-year follow-up, the patient demonstrated full recovery of elbow flexion–extension and satisfactory forearm function. A narrative literature review was also conducted, focusing on hybrid injury variants. Results: Intraoperative examination under anesthesia revealed good elbow stability with 130° flexion, 15° extension lag, and forearm pronation/supination of 70°/60°. An initial Mayo Elbow Performance Score (MEPS) of 65 was recorded, limited by range of motion and stability. Pain during passive mobilization was mild, with a Visual Analogue Scale (VAS) score of 3/10. Postoperative recovery included 15 days of immobilization followed by structured rehabilitation. At two years, the patient regained full elbow flexion–extension but had residual deficits in pronation–supination, attributed to pre-existing conditions. Conclusions: This case illustrates a previously unreported hybrid Monteggia variant, combining features of Monteggia, Galeazzi, and Essex–Lopresti injuries. It highlights the limitations of current classification systems and supports the need for an expanded diagnostic framework. Successful management required a multidisciplinary surgical approach tailored to the injury’s complexity. Further studies are warranted to refine classification and treatment strategies for these rare combined injuries. Full article

Monteggia fractures represent complex injuries requiring careful assessment and surgical intervention. This case report presents a rare variation of a Bado type I Monteggia fracture–dislocation that resembles features from the Jupiter subclassification type IID. A 39-year-old male sustained a high-energy injury while riding an all-terrain vehicle, resulting in a proximal segmental ulnar shaft fracture with anterior radial head dislocation. Open reduction and internal fixation (ORIF) of the ulna using a pre-contoured proximal ulna low-contact dynamic compression plate (LC-DCP) successfully restored alignment, leading to spontaneous reduction of the radial head. The postoperative course was uneventful, with satisfactory healing and functional recovery. This case underscores the importance of meticulous ulnar reconstruction in Monteggia fracture–dislocations and contributes to the limited literature on anterior radial head dislocation patterns. Full article

Background/Objectives: Various surgical methods have been proposed for the treatment of comminuted Mason III/IV radial head fractures. In particular, the advantages and disadvantages between prosthesis implantation (RHA) or radial head resection (RHR) are not sufficiently quantified in the current literature. Methods: A systematic literature search was conducted using PubMed Web of Science, Cochrane Library, and Embase in February 2024. Studies conducted on patients with Mason type III or IV radial head fractures and studies relating to surgical methods, including radial head resection or Radial head prosthesis implantation, were included. The two methods were evaluated in terms of clinical and functional results through the DASH score (Disability of the arm, shoulder, and hand), Mayo Elbow Performance Index (MEPI), and flexion-extension range of motion. The onset of osteoarthritis and complications were also assessed. Risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 345 articles were evaluated and, of these, 21 were included in the study for a total of 552 patients. The results of the meta-analysis showed no significant differences in favor of RHA or RHR in terms of Mayo Elbow Performance (p = 0.58), degrees of flexion (p = 0.689), degrees of extension deficit (p = 0.697), and overall incidence of complications (p = 0.389), while it highlighted a statistically significant difference in terms of DASH score (19.2 vs. 16.2, respectively; p = 0.008) and subjects who developed osteoarthritis (13.4% vs. 47.3%, respectively; p = 0.046). Conclusions: The results of this meta-analysis confirm that both surgical methods provide good functional outcomes, with no significant differences in MEPI, DASH, and range of motion. However, a higher incidence of post-traumatic osteoarthritis was observed in patients undergoing RHR. Additionally, RHR patients exhibited slightly worse functional outcomes in the DASH score; however, this difference is not substantial enough to be considered clinically significant. These findings suggest that while both techniques are viable, RHA may be preferable in patients at higher risk of joint degeneration and instability, and the choice of treatment should be tailored to individual patient characteristics. Full article

Background/Objectives: According to the modified Mason classification, radial head fractures can be treated with open reduction and internal fixation (ORIF), radial head arthroplasty, or resection. This study by the Department of Traumatology and Orthopedics of the Military Institute of Medicine aimed to compare the clinical and radiological outcomes of fractures treated with ORIF. Methods: This retrospective study analyzed 55 patients with radial head fractures treated between April 2020 and February 2023. Fractures were classified using Mason system as 15 type II, 26 type III, and 14 type IV. Clinical outcomes were evaluated using the VAS for pain, Broberg–Morrey scale, and the DASH questionnaire, alongside assessments of range of motion, grip strength, and elbow stability. Follow-up radiographs examined bone union, bone fragments displacement, degenerative changes and periarticular ossification. Results: The mean follow-up period was 21.0 ± 10.2 months. There were no statistically significant differences in VAS scale results for Mason types II, III, and IV fractures (4.0 vs. 6.0 vs. 5.0, respectively; p = 0.825), the Broberg–Morrey scale (82.0 ± 15.2 vs. 80.9 ± 15.5 vs. 84.2 ± 15.1, respectively; p = 0.845), or the DASH questionnaire (10.0 vs. 11.7 vs. 17.5, respectively; p = 0.937). Mean extension deficit and supination angles were at the limit of statistical significance (p = 0.076 and p = 0.051). No cases of lateral instability were observed, whereas medial instability was seen in only one case. Bone union was observed in 97.5% of cases, with elbow joint osteoarthritis and periarticular ossification in 15.0% and 45.0% of cases, respectively. Conclusions: Mason type II, III and IV radial head fractures treated with open reduction and internal fixation showed good functional and radiological outcomes with rare complications, including degenerative changes, periarticular ossifications and nonunion. Full article

A seven-month-old male Pomeranian presented with left forelimb lameness after a fall. Radiographic assessment confirmed proximal radial head and ulnar comminuted fracture. The initial surgical intervention involved the use of hybrid external skeletal fixation (ESF) to stabilize the radial head, concomitant with the application of a composite of bone morphogenetic protein type 2 (BMP-2)-loaded hydroxyapatite and gelatin microparticles at the fracture site. Although successful radial head healing was achieved, the ESF pinholes caused a defect in the proximal ulnar diaphysis. Subsequently, the ESF was removed, and a locking plate was applied in conjunction with the BMP-2-loaded collagen membrane to correct the radius defect. Clinical follow-up at 4.8 years postoperatively revealed a mildly decreased range of motion of the affected elbow joint, but no clinical symptoms such as lameness. Radiography revealed minimal degenerative changes and a radioulnar synostosis. Computed tomography revealed differences in the leg length and bone density. Gait analysis revealed that the left forelimb had a significant improvement in weight-bearing capacity based on weight distribution–peak vertical force metrics, compared with the right forelimb. Based on clinical outcomes, the combined application of hybrid ESF and bone tissue engineering techniques can be considered a feasible alternative treatment for radial head fractures. Full article

Introduction: Mason Type 3 radial-head fractures are typically treated with open reduction and internal fixation (ORIF) or radial-head arthroplasty (RHA). Prosthetic options include traditional monobloc implants and newer modular implants designed to match patient anatomy. While short- and medium-term outcomes of metallic RHA are generally favorable, this study aims to compare the long-term outcomes of patients treated with monobloc versus modular implants. Methods: The medical records of all the patients who underwent RHA at a level I trauma center between 2000 and 2011 were retrospectively reviewed. Patients who were available for follow-up were invited for reassessment, which included physical examination, questionnaires for the assessment of elbow pain and function, and follow-up radiographs. Results: Out of 35 patients who had RHA, 13 (37%) had a monobloc prosthesis and 22 (63%) had a modular prosthesis. Out of the patients that could be traced, 4 patients from the monobloc group and 10 patients from the modular group agreed to participate in the study. The mean follow-up time was 15 years in the monobloc group and 12.4 years in the modular group. Patients in the modular group demonstrated superior functional outcomes compared to the monobloc group, with statistically significant improvements in MEPS and DASH scores and a non-significant trend towards better ASES scores and VAS scores. Physical examination revealed a decline in function in the operated arm for both groups, with statistically significant differences favoring the modular group in elbow flexion and extension. Radiographic analysis showed varying degrees of implant loosening, with the modular group exhibiting less loosening compared to the monobloc group. Mild degenerative changes and heterotopic ossification were also observed, predominantly in the modular group. Conclusions: The results suggest that modular implants offer superior functional outcomes compared to monobloc implants. The modular group showed statistically significant improvements in elbow flexion and extension. These findings indicate that modular implants may be a more favorable option for enhancing patient outcomes. Further research with larger sample sizes is recommended to confirm these trends and to better understand the long-term benefits of modular implants. Full article

Purpose: The primary aim of the present study was to assess the prevalence of chronic lesions of the central band of the interosseous membrane (cbIOM) in complex elbow instability (CEI) in a consecutive series of patients who had previously undergone surgical treatment for Mason II and III radial head (RH) fractures. The secondary aim was to define its clinical significance. Methods: We performed a retrospective study on a prospective database. Our study population comprised 93 patients affected by CEI with type II or III RH fractures according to Mason’s classification who were analyzed in the chronic setting. All patients were treated according to the current therapeutic algorithms. At the last follow-up, the “muscular hernia sign” was investigated by means of a bilateral ultrasonographic examination to assess any chronic cbIOM lesions; the Mayo Elbow Performance Score (MEPS) was used to evaluate the clinical significance of these lesions. Results: All 93 patients were assessed after a mean time of 7.3 years (range: 2–12). No positive “hernia signs” were found, while five patients (5.4%) displayed an increased laxity of the cbIOM when compared with the contralateral side despite a negative “hernia sign”. The clinical outcome in all five patients was excellent with a mean MEPS of 96 (range, 90–100). Conclusions: Chronic cbIOM lesions are very rare in CEI with RH fractures. No patients in this large sample displayed a cbIOM complete lesion; in cases with increased laxity, satisfactory mid-term clinical results were observed. Considering that previous studies reported (1) a high prevalence of cbIOM lesions in patients with Mason II and III RH fractures and (2) the current expert opinion about the scarce healing potential of the cbIOM, this study also suggests that the IOM may heal better than previously believed when RH fractures are treated appropriately in the acute setting. Full article

Background: Monteggia-equivalent fractures are similar to Monteggia fractures but involve different patterns and locations. When these fractures include a severe radial head fracture, radial head arthroplasty (RHA) should be considered. RHA can be performed using Kocher’s approach or the less commonly used trans-olecranon approach, which has been less studied. This study evaluates the clinical and radiological outcomes of the trans-olecranon approach for RHA over 15 years. Methods: In this retrospective study, 45 cases of Monteggia-equivalent fractures were analyzed, focusing on patients over 18 with radial head fractures, treated by the same surgeon with RHA and open reduction and internal fixation (ORIF) of the proximal ulna via the trans-olecranon approach. Results: The cohort of 45 patients showed a mean flexion of 112.37° ± 13.7°, mean extension of 24.27° ± 17.9°, mean supination of 57.63° ± 28.9°, and mean pronation of 62.16° ± 29.07°. Clinical and radiographic measurements indicated satisfactory results, with acceptable complication and secondary procedure rates. Conclusion: The trans-olecranon, single-incision approach is effective for managing fractures involving the proximal ulna and radial head, offering adequate access to lateral elbow structures while minimizing damage to surrounding soft tissue. Therefore, this approach should be considered for patients presented with a Monteggia-equivalent fracture and an indication for RHA. Full article

Background: Monteggia fractures entail a proximal ulnar fracture with associated radial head dislocation. Primarily observed as a fracture in the pediatric population, there have been rare occurrences in adults. In rare instances, various associated fractures have been reported with Monteggia fractures. However, during our literature review, a type I Monteggia fracture had not been reported along with ipsilateral diaphyseal humerus and capitellar fractures. Here, we present a successful post-operative outcome for a unique fracture distribution and form of fixation that has yet to be reported in the literature. Full article