37 COMPLEX RADIAL FRACTURES: RESULTS OF TREATMENT USING FLOATING HEAD PROSTHESES OUR EXPERIENCE OVER 5 YEARS

Abstract

We have achieved a retrospective study in 37 cases of complex radial heads fractures (By Morrey classification). We used the Judet bipolar prosthesis (1996) because it has an integrated articulation that allows an arc of motion of 35°. We revised clinical indication and surgical technique. We analyse clinical and radiographics findings with Bro-berg-Morrey scoring system (1986) for clinical outcome and radiographic Morrey evaluation (1981).

Material: We report our experience over 5 years (since April of 2000 till June 2005) with floating radial head prosthesis over 36 patients. A bilateral case; and a 38 months of medial follow-up (range, 12 to 74 months).

We made a clinical and radiographic control at 1, 3, 6 and every 12 months. We used the Broberg and Morrey scale to value the clinical results; and the radiographic value scale of the same author.

The diagnosis distribution was the following:

• 16 luxation fracture (Masson type-IV fracture)

• Monteggia variety

• posttraumatic stiffness after primary treatment

• Hotchkiss “terrible triad”

• associated MCL tears

Results: There were two complications: 2 infections, only in one of them we needed to take away the implant. Its represented a 5,3%. We took away one prosthesis for a infection and another for a insufficient osteothomia (“overstuffing”). We had 2 cases of neuropatya (posterior interosseous and cubital) but it resolved without surgery. Six stiffness, four of them were posttraumatic stiffness, then there were stiffness before surgery. 1 case of osteolysis and prosthesis instability after 5 years.

The clinical results were:

• Excellent 21, 6% (8 cases)

• Good 56, 7% (22 cases)

• Fair 13, 5% (5 cases)

• Bad 8% (3 cases)

Conclusion: The excellent-good result were 78,3% but there were much better in acute surgery (86,1%) than in secondary or delayed surgery (50%) Bypolar design allows a continuous contact against the convex humeral condyle during elbow movement. This clinical results confirm that floating prostheses is well tolerated and it can prevent proximal migration and provide stability while bone and soft tissue heal. From biomechanical point of view, this anatomic design may lead to longer functional lifetime compared with the standard metal prosthesis.

In summary the floating head prostheses is a useful option in Masson III fracture associated with elbow dislocation with or without associated destabilizing fractures but is not free of complications.