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Beitragstitel Surgical technique for radial head fractures with more than 3 fragments: A new concept of fixation
  1. Timothée Helmstetter Réseau hospitalier neuchâtelois Vortragender
  2. Mauro Maniglio CHUV - Centre hospitalier universitaire vaudois
  3. Paolo Fornaciari HFR Fribourg Cantonal Hospital, University of Fribourg
  4. Moritz Tannast HFR - Hopital Cantonal Fribourgeois
  5. Philippe Vial HFR Fribourg Cantonal Hospital, University of Fribourg
Präsentationsform Poster
  • A01 - Schulter/Ellbogen
Abstract INTRODUCTION: The treatment of comminuted radial head fractures (RHF) type III/IV of the Mason Johnston’s classification still remains controversial. According to the current literature, RHF with more than three parts are not suitable for repair. Therefore, most authors suggest a primary radial head arthroplasty (RHA). Nonetheless, in case of unstable elbow injuries, the management of multifragmentary RHF with radial head replacement seems to have 25% risk of reoperation due to stiffness and painful loosening. Under this scenario, given the improvement of reduction and fixation technique we enlarged the indication of osteosynthesis before RHA. The purpose of this retrospective study is to determine the functional results in terms of the Broberg and Morrey score and radiological failure rate following open reduction and internal fixation (ORIF) with headless compression screws and/or 1.0-2.8 plates of RHF with more than three articular fragments. METHODS: A retrospective single-center case series. Between 2012 and 2019, patients who had undergone ORIF of RHF with more than three articular fragments were included. We standardized some critical steps of the surgery in all our cases: we used a ventralized approach using extensor split, respected the annular ligament, and used low profile implants (headless screws, plates with a thickness of 1.3mm). Nine patients, with an average age of 52 years had a clinical and/or radiological average follow-up of 47 months. RESULTS: The preoperative radiographs and CT scans identified 8 fractures with 4 fragments and 1 with 5 fragments. Four fractures were classified as Mason III and 5 as Mason IV. Four patients underwent osteosynthesis with plate and screws while 5 patients with screws only. For the 8 patients who retained the radial head, the mean Broberg and Morrey score was 94 points (range, 75 to 100 points) the result was rated as excellent in five patients, good in two and fair in one at the final follow-up. Overall, seven of the nine patients (77%) had satisfactory results. Postoperatively, one patient of nine (11%) showed a fixation device failure after 6 weeks and sustained a RHA. All other patients showed radiological healing of the fracture with an average of 3 months. CONCLUSION: According to our results, there are many occasions, where ORIF can be successfully applied in case of RHF with more than 3 fragments.
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