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Partial radial head allografts show promise for elbow fracture voids
Partial radial head allografts restore anatomic shape and provide rigid fixation, surgeon says.
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Partial radial head allografts may be useful alternatives to radial head implants in partial radial head deficiencies for elbow fracture dislocations, according to a study presented by Robert Geoffrey Turner, MB, BCh, at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans, U.S.A.
Turner, of Shropshire, U.K., noted that this study was performed at the Mayo Clinic, in Rochester, Minnesota.
He said that the few reports available on total radial head allografts have shown variable outcomes. In addition, the use of partial radial head allografts has not been previously reported upon. According to Turner, the primary advantage of partial radial head allografts is their ability to restore anatomic shape as well as rigid fixation.
“We believe that the intact portion of the radial head is orientated correctly, and it also provides a stable base for the allograft to be fixed to,” he said.
Methods of treatment
“Our treatment strategy is the same we use for any terrible triad injury,” Turner said. “We would try and restore the bones first of all, dealing with the deficient radial head and the coronoid fracture, then repair the ligaments and try early active mobilization.”
Within the study, eight patients with terrible triad injuries were treated with fresh-frozen partial radial head allografts in addition to open reduction and internal fixation (ORIF) of the coronoid and collateral ligament repair.
In each case, Turner reported, ORIF of the radial head was impossible or the fragments had already been excised. Two cases were acute and six were referred 2 to 48 weeks after failure of primary treatment.
Turner’s group contacted the patients at a mean of 79 months after treatment. Their mean Mayo Elbow Performance score was 78 and their mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was 23. Clinical and radiological review confirmed union of the graft in all cases, and none showed evidence of collapse or fragmentation due to avascular necrosis. Two patients underwent computed tomography scans, which confirmed for Turner and his group that those patients experienced perfect bony integration.
Three patients experienced coronoid resorption and were treated with an external fixator that can be used in extreme instability cases. These patients had “fair” elbow scores, and the five patients without coronoid resorption had “good” or “excellent” elbow scores.
According to Turner, two patients subsequently required arthrolysis, and two required a procedure for persistent posterolateral rotatory instability. One patient, who ultimately experienced a good functional outcome, required debridement for infection, and one underwent a total elbow arthroplasty after developing a charcot joint. The host-graft union was confirmed in all cases.
“Encouraging” results
“The results of partial allograft radial head seem to be encouraging,” Turner concluded. “We didn’t have any subchondral collapse in the short or medium term. We believe that this is a benefit because the radial head restores the anterior buttress, and if the buttress is restored the radial head can then transmit the force of the capitellum, taking the forces away from the coronoid and ligament repair while those are healing.”
Turner noted that the absence of late resorption might be explainable on the basis of rigid fixation and avoiding prolonged stress shielding. — by Robert Press
Reference:
- Turner RG, Wolinsky PR. Partial allograft radial head replacement. Paper #337. Presented at the 2010 American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.
- Robert Geoffrey Turner, MB, BCh, can be reached at Department of Orthopaedics, Princess Royal Hospital, Telford, Shropshire, U.K.; e-mail: rob.turner@virgin.net.
