Arthroscopic surgery for radial head fractures a prospective study about 9 cases
P.Croutzet, J.Kany, R. Guinand
Société Européenne pour la Chirurgie de l'Epaule et du Coude – Istanbul, Septembre 2014
The main complication of radial head fracture is elbow stiffness, mainly consequence of ligament injuries due to the trauma and those due to the surgery Aim : Using an arthroscopic procedure for reduction and internal fixation : - enabling a complete diagnosis of ligament impairments (medial, volar, lateral) - sparing the collateral lateral and annular ligaments during the reduction and fixation
Over a 2-year period, 9 displaced fractures were operated with arthroscopy. We only retained recent Mason 2 & 3 fractures without dislocation. We used 3 portals, percutaneous cannulated screws, an antalgic splint for 3 weeks and an immediate activo-passive physiotherapy.
Physical examination and X-ray were done after 3, 6 and 12 weeks. Analysis criteria were: -perioperative: ligament impairment, time of surgery -post-operative: motion, grasp strength, time without working and sports, X-ray analysis.
Time of surgery went down from 90 to 40 minutes; annular ligament was initially intact in 7/9 cases. Active range of motion was : at 3 weeks : F/E 90°, P/S 150°, at 6 weeks : F/E 110°, P/S 160° ; at 12 weeks : F/E 120°, P/S 160° We noticed 7 anatomic reductions (all Mason 2) and no secondary displacement. Time without working was 3 weeks (0-12)
Active motion was almost fully recovered after 6 weeks. The absence of secondary displacement suggests benefits of harder initial rehabilitation. Range of motion is at the minimum the same as other studies with shorter convalescence. None second time surgery was needed.
Arthroscopic surgery for radial head fracture is a reliable and efficient procedure enabling rapid recovery.