Fracture Pattern Influences Radial Head Replacement Size Determination Among Experienced Elbow Surgeons

ESSKA Elbow and Wrist Committee 2016–2018

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: Correct sizing is challenging in radial head replacement and no consensus exists on the implant’s optimal height and width to avoid elbow stiffness and instability. Studies exists, suggesting how to appropriately choose the implant size, but the manner by which the fracture pattern influences the surgeons’ operative choices was not investigated. Methods: The radial heads of four fresh-frozen cadaveric specimens were excised, measured, and fractured to simulate four patterns: three fragments (A); four fragments (B); comminuted (C); comminuted with bone loss (D). Nine examiners were asked to indicate first the maximum diameter of the radial heads with the help of dedicated sizing dishes and then the appropriate implant size with trial implants. Accuracy and precision were determined. A coefficient of variation was calculated and agreement was evaluated with the Bland–Altman method. Results: Accuracy and precision of radial head diameter estimation with dedicated sizing dish were 96.73% and 93.64%, (best pattern, D; worst, C). Accuracy and precision of radial head diameter estimation with trial implants were 99.71% and 90.66% (best pattern, A; worst, D). Frequent modifications occurred between the initial radial head size proposal based on the sizing dish and the radial head size chosen after use of the trial implants (47.2%). Conclusions: Diameter estimation of radial heads with dedicated sizing dishes may be underestimated in comminuted fractures; when bone loss is present, this may lead to an overestimation, especially when using trial implants. Care is essential to determine the optimal size of the implant and to avoid overlenghtening and oversizing, which can be responsible for implant failure. Level of Evidence: Basic Science Study. Clinical Relevance: Knowledge of the manner by which the fracture pattern influences radial head replacement size estimation can help preventing overlenghtening and oversizing during this procedure.

Original languageEnglish
Pages (from-to)539-547
Number of pages9
JournalIndian Journal of Orthopaedics
Volume54
Issue number5
DOIs
Publication statusPublished - 1 Sept 2020
Externally publishedYes

Funding

DC declares that he has no conflict of interest. FL declares that he has no conflict of interest. AC declares that he has no conflict of interest. AM declares that she has no conflict of interest. RB declares that he has no conflict of interest. KW declares consultancy for Arthrex, Medartis and Tornier, outside the submitted work; payment for travel/accommodations expenses from Arthrex, Medartis and Tornier, outside the submitted work; institutional grants from Medartis and Tornier, outside the submitted work. DE is educational consultant for AO and educational consultant for Lima. PR declares payment for consultancy from Arthrex, Depuy, Microport and Medacta, outside the submitted work. PA declares payment for development of educational presentations from Arthrex, outside the submitted work.

FundersFunder number
Boris Hollinger
Claudio Rosso
Enrico Guerra
Kilian Wegmann
Luigi Pederzini
Medartis and Tornier
Michel van den Bekerom
Oskar Zupanc
Raul Barco
Arthrex

    Keywords

    • Agreement
    • Anatomical study
    • Elbow
    • Fracture
    • Prosthesis
    • Radial head
    • Replacement

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