Background

Total hip arthroplasty (THA) has been and continues to be the gold standard for treatment of end-stage osteoarthritis. With each year, implant characteristics are evolving to increase patient-reported outcomes and decrease complications. Purpose: to report minimum 2-year outcomes and complications in patients who underwent robotic-arm assisted THA using Corin versus Stryker-type implants.

Background

Long term success of any shoulder joint reconstruction procedure involving subscapularis attachment take down is dictated by the way one chooses to release and repair/reconstruct the subscapularis insertion. There are several methods that were reported in the literature without any preset guidelines which are easily reproducible.

To study the surgical outcome of multi-fragmentary, un-reconstructable radial head fractures managed acutely by a radial head prosthetic replacement, we retrospectively reviewed nineteen radial head fractures that were treated acutely with a radial head replacement, over a four-year period in three district general hospitals. Nineteen patients were clinically and radiologically assessed for this study. Functional assessment was performed with the Mayo elbow performance score (MEPS).

No patient achieved full functional range of motion. The average range of flexion was 110° (range 80° to 120°), average extension deficit of 35° (range 30° to 45°), average pronation was 35° (range 0° to 65°), and average supination was 50° (range 30° to 85°). Complications included implant removal due to loosening (n=1), elbow stiffness (n=2), and instability (n=1), the latter case requiring a revision of the radial head prosthesis. Some degree of persistent discomfort was noticed in all cases. Five patients were tolerant of the final functional outcome. The average Mayo elbow score was 68/100 (range 55 to 80). One patient had an intra-operative fracture of the radial metaphysis during insertion of the implant.

Radial head fractures with fragment displacement should be reduced and fixed, when classified as Mason II type injuries. We describe a method of arthroscopic fixation which is performed as a day case trauma surgery, and compare the results with a more traditional fixation approach, in a case controlled manner.

We prospectively reviewed six Mason II radial head fractures which were treated using an arthroscopic reduction and fixation technique. The technique allows the fracture to be mobilised, reduced, and anatomically fixed using headless screws. All arthroscopic surgeries were conducted as day-cases. We retrospectively collected age and sex matched cases of open reduction and fixation of Mason II fractures using headless screws.

The arthroscopic cases required less analgesia, shorter hospital admissions, and had fewer complications. The averaged final range of follow-up, at 1 year post-operation was 15 to 140 degrees in the arthroscopic group and 35 to 120 degrees in the open group. The Mayo Elbow Performance Score was 95/100 and 90/100 respectively. No acute complications were noted in the arthroscopic group, and a radial nerve neuropraxia [n=1], superficial wound infection [n=1], and loose screw [n=1]. Two patients of the arthroscopic group required secondary motion gaining operations [n=1 arthroscopic anterior capsulectomy for a fixed flexion contracture of 35 degrees, and n=1 loss of supination requiring and arthroscopic radial scar excision]. Three patients in the open group required secondary surgery [n=2 arthroscopic anterior capsulectomy for fixed flexion deformities, and n=1 arthroscopic anterior capsulectomy for fixed flexion deformities, and n=1 arthroscopic radial head excision for prominent screws, loss of forearm rotation, and radiocapitellar arthrosis pain].

The technique of arthroscopic fixation of Mason II radial head fractures appears to be valid, with respect to anatomical restoration of the fracture, minimal hospital admission, reduction in analgesia requirement, fewer complications, and a decreased need for secondary surgery.

Purpose- To study the surgical outcome of multi-fragmentary, un-reconstructable radial head fractures managed acutely by a radial head prosthetic replacement.

Materials- We retrospectively reviewed fifteen radial head fractures that were treated acutely with a radial head replacement, over a four-year period, in three district general hospitals. Fifteen patients were clinically and radiologically assessed for this study. Functional assessment was performed with the Mayo elbow performance score (MEPS).

Results- No patient achieved full functional range of motion. The average range of flexion was 110° (range 80° to 120°), average extension deficit of 35° (range 30° to 45°), average pronation was 35° (range 0° to 65°), and average supination was 50° (range 30° to 85°). Complications included implant removal due to loosening (n=1), elbow stiffness (n=2), and instability (n=1), the latter case requiring a revision of the radial head prosthesis. Some degree of persistent discomfort was noticed in all cases. Five patients were tolerant of the final functional outcome. The average Mayo elbow score was 68/100 (range 55 to 80). One patient had an intra-operative fracture of the radial metaphysis during insertion of the implant.

Conclusions- Radial head replacement in general orthopaedic, low volume, practice failed to achieve satisfactory results. Contrary to popular belief, it is a technically demanding operation, for which surveillance should be continued for a minimum of one year. Strict indications for prosthetic replacement should be followed and implant selection has yet to be proven to make a significant positive contribution.

Our review highlights the need for a stricter adherence to indications, surgery should not be under-estimated and devolved to trainees, and our understanding of the radial axis of the elbow and forearm remains relatively rudimentary.

Purpose: Distal humeral fractures are often difficult injuries to treat. We hypothesise that more complex distal humeral fractures have unacceptable functional outcomes due to multi-factorial reasons.

Methods: 42 patients with AO/ASIF type B and C fractures of the distal humerus who were treated with open reduction and internal fixation over a six year period were included in the study. All patients were from a single district general hospital. 37 (88%) were clinically, radiologically, and functionally assessed for this study, with the remainder either lost to follow-up or expired.

Results: There were 21 type B and 16 type C fractures, all managed by open reduction and internal fixation. Various fixation techniques were utilised. These were performed by consultant surgeons in 14 cases and by surgeons in training in 23 cases. Average follow up was 38 months (range 22–54 months). The arc of elbow motion was 94 degrees (range 58–130), with an average extension deficit of 28 degrees (range 20–55) and an average flexion deficit of 32 degrees (range 15–45). The average arc of forearm rotation was 136 degrees (range 45–140), with an average supination of 68 (range 35–85) and an average pronation of 72 (range 45–90). The complications (n=20/37) included superficial skin infection (n=4), ulnar nerve neurapraxia (n=3), non-union of the humerus fracture (n=2), non-union of olecranon osteotomy site (n=1), intra-articular screw placement (n=1), loosened plate (n=1), loose/backed out screw (n=2), fixed flexion deformity (n=4) and mild elbow instability (n=2). Second surgery was performed in 24% (n=9/37), revision of metal work (n=2), bone grafting (n=2), anterior capsulectomy (n=4), and removal of screw (n=1).

Conclusions: Fractures of the distal humerus are often more complex than appreciated, and challenging to treat, with respect to fracture union and functional outcome. A generalist practice appears adequate for achieving bony union, but inadequate for obtaining low complication rates and functional outcomes. Our data suggest that such injuries may constitute a fracture group requiring the acute intervention by centres that have specific sub-specialisation and adequate rehabilitation facilities