Comminuted head fractures remain a vexing problem. Excision is not recommended when the fracture is associated with instability of the elbow or forearm. The use of newer implants has offered optimism for treatment of this injury. This study used the Judet biploar radial head prosthesis for replacement of comminuted fractures of the radial head in selected patients. A small series of 14 patients is presented. There were 10 men and 4 women with a mean age of approximately 45 years. The fractures were classified according to the modification of the Mason classification. There were six type three or comminuted fractures of the head or neck. The other eight patients had type four injuries with posterior dislocation of the elbow. The operations were performed by four different surgeons and all were performed within eight days of injury. Following implantation of the prosthesis, intraoperative stability of the elbow was achieved in all patients and no repairs of the medial ligament or distal radioulnar joint were performed.
Of the 14 patients initiated into the cohort, one died and one was lost to follow-up. The remaining 12 patients returned for assessment at a mean of almost five years from surgery. Six patients had pain-free elbow, and five complained of pain on activity. One patient had permanent pain requiring analgesics. This patient was diagnosed with a complex regional pain syndrome. All of the elbows and wrists were stable with no cubitus valgus and no pain in the wrist was noted. There were no cases of recurrent dislocation of the elbow or dislocation of the prosthetic head. Mean arc of range of motion was between 14 and 140 degrees. Supination averaged 84 degrees and pronation 88 degrees. The only notable complication was the one patient with complex regional pain syndrome. Mayo elbow performance score showed that six patients had excellent result, four good, one fair and one poor. The DASH was also impressive. There was some mild heterotopic calcification found in seven elbows but none was clinically significant.
This small cohort lends support for use of the Judet floating radial head prosthesis in fractures and fracture-dislocations of the elbow. The indications for prosthetic radial head replacement is still evolving. However, dislocation of the elbow or instability of the forearm are fairly concrete indications. The question of whether or not a bipolar head makes a difference still remains to be determined. Monoblock metallic prostheses have also been reported to achieve satisfactory results. However, the may be greater radiolucency around the stem and osteoporosis about the capitellum. These may be related to uneven loading. This has to be balanced against the potential for polyethylene wear in the bipolar designs.
Radial, Head, Prosthesis, Bipolar, Judet, Fracture, Elbow
J Bone & Joint Surg