Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an anatomical locking plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.
Accidental Falls ; Aged ; Arthroplasty, Replacement ; methods ; Elbow Joint ; Female ; Fracture Fixation, Internal ; Humans ; Joint Instability ; Magnetic Resonance Imaging ; Open Fracture Reduction ; Radius ; diagnostic imaging ; surgery ; Radius Fractures ; diagnostic imaging ; surgery ; Treatment Outcome

BACKGROUNDInfection and aseptic loosening are common complications of total elbow arthroplasty (TEA) and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems.

METHODSWe conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients' data were collected to evaluate the clinical outcome.

RESULTSAll patients had a Grade III ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session.

CONCLUSIONSInserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.

Arthroplasty, Replacement ; methods ; Elbow ; surgery ; Female ; Humans ; Male ; Middle Aged ; Prostheses and Implants ; Radius ; surgery ; Range of Motion, Articular ; Reoperation ; methods ; Retrospective Studies ; Treatment Outcome ; Ulna ; surgery

Arthroplasty, Replacement, Elbow ; Elbow Joint ; injuries ; surgery ; Fracture Fixation ; Humans

Total elbow arthroplasty was initially used to manage the rheumatoid arthritis of elbow. With the developement of technology in recent decades, the indication of total elbow arthroplasty include the trauma associated unstable joint, traumatic arthritis and distal humerus fractures in elderly. But the high risk of complications, which includes infection, ulnar nerve deficit and tricep insufficiency, is still an unsolved issue. The most widely used approach nowadays is the Bryan-Morrey approach, while some authors also report triceps on approach recently. This article is an overview in approaches and biomechanical researches of total elbow arthroplasy by reviewing the domestic and overseas involved literatures.
Arthroplasty, Replacement, Elbow ; adverse effects ; methods ; Humans ; Muscles ; physiopathology ; Recovery of Function ; Ulnar Nerve ; injuries

OBJECTIVETo assess the early efficacy of metallic modular radial head prostheses in patients with Mason III and IV unreconstructable radial head fractures.

METHODSThe medical records of 16 patients (9 males, 7 females) with a mean age of 43 years old (31 to 57) with Mason III/IV unreconstructable radial head fractures requiring metallic modular radial head replacement between January 2009 and March 2012, were reviewed retrospectively. The functional results were assessed by range-of-movement, Mayo elbow performance score (MEPS). All patients underwent radiographic evaluation for radial head height and radiolucent lines.

RESULTSFourteen patients were evaluated with follow-up for 12 to 33 months with an average of 23 months. Range of movement parameters was significantly lower in the affected elbow than in the unaffected side (P < 0.01). MEPS results were excellent in 9 cases, good in 2 cases, fair in 2 cases, and poor in 1 case. According to Grewal grading, there were 4 cases of periprosthetic lucencies of the radius and 1 case had significant clinical signs of loosening.

CONCLUSIONRadial head replacement with the metallic modular prostheses yields satisfactory results regarding range of motion and function of the elbow joint in short term. The evolution of this prostheses needs to be evaluated with further studies to assess mid-term and long-term follow-up results.

Adult ; Arthroplasty, Replacement, Elbow ; methods ; Female ; Fracture Fixation ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius ; surgery ; Radius Fractures ; physiopathology ; surgery ; Retrospective Studies

PURPOSE: To analyze clinical presentation and results of the treatment of periprosthetic fractures occurring after total elbow replacement (TER). MATERIALS AND METHODS: Eleven patients who had periprosthetic fractures after TER were examined. The locations and the causes of periprosthetic fractures were evaluated. The periprosthetic fractures were classified using Mayo classification. Stable fractures were treated conservatively, and unstable fractures were treated by open reduction and internal fixation. Revision operation was conducted if implant loosening was observed. End results after treatment were evaluated based on Mayo elbow performance score (MEPS) and radiologic examinations. RESULTS: Most fractures occurred at the humeral site(82%), and Type B2 periprosthetic fracture was most frequently observed(64%). Radiographic union was observed at a mean of 26 weeks after the treatment. No statistically significant differences were observed between preoperative and postoperative elbow active motions. According to the MEPS, the results were rated as excellent in three patients, good in five, fair in one and poor in two. CONCLUSION: A periprosthetic fracture after TER likely occurrs at humeral site and it is highly related with loosening of the implant. Although union tends to be delayed and complications occur frequently, relatively fair results can be obtained with appropriate treatment.
Arthroplasty, Replacement, Elbow ; Elbow ; Humans ; Periprosthetic Fractures

OBJECTIVETo discuss the efficacy of total elbow replacement in the treatment of complex distal humeral fractures.

METHODSFrom May 2005 to October 2008 12 patients were retrospectively studied who were diagnosed complex fractures of the distal humerus and treated by total elbow replacement (Coonrad-Marrey). The mean age was 60 years old, the mean follow-up time was 12 months. According to AO classification, there was 3 C2 and 9 C3. The study included: pain evaluation, range of motion, elbow stability, muscle strength, complications, Mayo elbow score, DASH score, radiological assessment of ectopic bone formation and loosening.

RESULTSTwo cases with mild pain. The mean flexion is 98.3 degrees, extension limit is 17.9 degrees, mean pronation is 82.9 degrees and supination is 70.8 degrees. All joints were stable postoperatively. All patients were satisfied with the outcome. There was 1 case of superficial soft tissue nonhealing and 2 cases of ulnar nerve symptoms. No ectopic bone formation or loosening was found. Mayo elbow score was 3 cases of excellent and 9 cases of good. The mean DASH score was 41.3.

CONCLUSIONTotal elbow replacement can be used in such conditions as severe osteoporosis, severe comminution that internal plates can not get stable fixation, severe cartilage damage (because of fracture or inflammatory arthritis) that indicate traumatic or inflammatory arthritis.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Elbow ; Female ; Follow-Up Studies ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Arthroplasty, Replacement ; Elbow Joint ; injuries ; surgery ; Fractures, Bone ; therapy ; Humans ; Joint Dislocations ; therapy

PURPOSE: Few studies have compared the outcomes, complications and revision rate of a total elbow replacement (TER) prosthetic design. This study examined a series of patients with semiconstrained and unconstrained total elbow replacements (TER) and evaluated them for any functional differences, complications and revision rates that might be attributable to the prosthetic design. MATERIALS AND METHODS: A total 78 cases of primary TER was performed in 71 patients. Their mean age at TER was 54 years. The causes of TER were rheumatoid arthritis in 42, post-traumatic arthritis and osteoarthritis 24 and 5 patients, respectively. Unconstrained and semiconstrained TER was employed in 35 and 43 cases, respectively. The end results of TER by the Mayo elbow performance score (MEPS), their elbow range of motion before and after surgery, their complications and revision rates after an average 13 year follow-up were evaluated. RESULTS: The MEPS was improved from 33 points pre-operatively to 87 points post-operatively (p<0.001). Active flexion-extension elbow motions were also improved markedly from 27degrees-86degrees pre-operatively to 16degrees-128degrees postoperatively (p<0.001). There was no significant difference between the semiconstrained and unconstrained TER in the post-operative MEPS (p=0.764) and range of motion (p=0.728). The complication rate was much higher in the unconstrained groups than in the semiconstrained group (p=0.014). The mean total revision rate was 29.5%. There was no significant difference in revision rate between the unconstrained and semiconstrained groups (p=0.402). Loosening was found in a total of 12 cases (15.4%). There was also no significant difference in loosening between the semiconstrained and unconstrained groups (p=0.382). CONCLUSION: Favorable results of MEPS and elbow motion were obtained in both the unconstrained and semiconstrained types after an average 13 year follow up after TER. However, the semiconstrained type of TER showed a lower complication rate than the unconstrained type of TER.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Elbow ; Elbow ; Follow-Up Studies ; Humans ; Korea ; Osteoarthritis ; Prostheses and Implants ; Range of Motion, Articular

OBJECTIVETo retrospectively review the results of Coonrad-Morrey semi-constrained total elbow arthroplasty (TEA) for the treatment of different elbow disorders.

METHODSBetween December 2003 and April 2008, 30 patients with different kinds of elbow disorders including elbow fracture, non-healing elbow fracture, rheumatoid arthritis and osteoarthritis were treated with TEA using the semi-constrained Coonrad-Morrey elbow replacement prostheses. One patient had bilateral total elbow replacements. There were 22 females and 8 males, with a mean age of 66 years (47 to 78).

RESULTSTwenty patients (21 elbows) were available for review. The average length of follow-up was 35 months (from 12 to 52 months). The mean Mayo elbow performance score was 84 points. Excellent results were achieved in 6 elbows (28%), 11 elbows had good outcome (52%), 2 elbows had improvement (10%), while the other 2 elbows had no improvement (10%). The 2 elbows with distal humeral fractures, had no pain after treatment but developed heterotopic ossification, which caused stiffness and lower the Mayo elbow performance score. One delayed healing of the wound, one patient experienced temporary radial nerve hypesthesia and one elbow showed transparent region around the implant without radiological sign of loosening in the implanted prostheses.

CONCLUSIONSThis study reveals good to excellent outcome with the use of semi-constrained TEA for the treatment of rheumatoid arthritis, elbow fracture, osteoarthritis and non-healing elbow fractures in elder patients. The non-healing elbow fractures in elder patients would accompany with severe osteoporosis and comminuted fracture, which would affect the result of open reduction internal fixation. So TEA may be one optimal treatment for these patients.

Aged ; Arthritis, Rheumatoid ; surgery ; Arthroplasty, Replacement ; instrumentation ; methods ; Elbow Joint ; surgery ; Female ; Follow-Up Studies ; Humans ; Humeral Fractures ; surgery ; Joint Prosthesis ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Retrospective Studies ; Treatment Outcome