Outcomes of Radial Head Replacement for Comminuted Radial Head Fractures. An Analysis of 405 cases
Raffy Mirzayan, MD1; Nikko Lowe, BS2; Bryan Lin, MS3; Daniel C Acevedo, MD4; Anshuman Singh, MD5
1Kaiser Permanente Southern California, Baldwin Park, CA; 2Kaiser Permanente, Baldwin Park, CA; 3Kaiser Permanente Southern California, Pasadena, CA; 4Kaiser Permanente Southern California, Panorama City, CA; 5Kaiser Permanente Southern California, San Diego, CA
Radial head replacement (RHR) is performed for comminuted radial head fractures (RHF). Outcome data is limited in the literature. We report the survivorship, patient-reported outcomes, and risk factors for revision by indication, manufacturer and implant head size, and patient demographics.
After IRB approval, we retrospectively analyzed RHRs performed at 14 medical centers in an integrated healthcare system between 2006 and 2017. Patients who underwent a RHR for traumatic RHF were included and divided into three categories: 1. Isolated (IRHF), 2. Terrible Triad (TTRHF) and 3. Monteggia variant. Patient demographics, comorbidities, occupation, mechanism of injury, indication, and manufacturer and size of the RHR were obtained from the electronic medical record. Patients were contacted via telephone at a minimum of 20 months to obtain QuickDash and Oxford scores. All statistical analyses were conducted with SAS (version 9.4; SAS Institute, Inc., Cary, NC) and statistical significance was set at P< 0.05.
Patient characteristic are summarized in Table 1. At time of analysis, 83% of the cohort was still enrolled in the captured healthcare system and 45% of patients were available for follow-up via telephone at a mean of 69+32 months. An Acumed (anatomic press fit) implant was used in 155 (38%) and a Wright Medical Evolve (smooth, metal implant) was used in 207 (51%) of cases. Outcomes of these 2 implants used for IRHF (Table 2) and TTRHF (Table 3) cases are summarized. Monteggia variants had significantly more reoperations (23%) versus TTRHF (18%) or IRHFs (10%) (p = 0.022) mostly due to ulnar hardware removal. TTRHF (18.4%) had significantly more overall re-operations than IRHF (10.4%) (P=0.04). The overall RHR revision rate was 7.4%, and it was positively correlated with increasing head size (Table 4). Kaplan-Meier survivorship for RHRs demonstrate that revision cases were performed within the first 36 months of the index procedure and plateaued after 3 years over the 12-year period (Figure 1).
This study has a few significant findings. First, there were no differences in outcome measures, complications and reoperations between the 2 implant types in either IRHF or TTRHF. Second, the risk of revision is low but is significantly correlated with radial head implant size. Finally, most revisions occur early and individuals who did not undergo a RHR revision by 3 years will retain the implant for over 10 years. Knowledge of these findings may guide surgeons in treating these injuries to help counsel patients accordingly.
Back to 2021 Abstracts