Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Pediatr Orthop. 2022 Feb 1;42(2):109-115. doi: 10.1097/BPO.0000000000002030.
The management of severe radiocapitellar joint pathologies in young patients is challenging. Radial head arthroplasty (RHA) is a treatment option in the adult population, but most surgeons avoid implementing it in younger patients, and there are no published results for patients younger than 16 years.
Our retrospective cohort describes 5 patients (4 male 1 female) who underwent cementless modular RHA at an average age of 14 years (range: 13 to 15). The preoperative diagnoses were post-traumatic radiocapitellar incongruity and arthrosis because of previous Salter-Harris type 3 or 4 fractures of the radial head in 3 cases; and axial instability of the forearm following failed radial head excision in 2 cases. Because of the complexity of the elbow pathology in these cases, all underwent concomitant procedures including: contracture release (5 cases), corrective ulnar osteotomy (2 cases), distal ulnar shortening osteotomy, excision of radioulnar synostosis, microfracture of the capitellum, and partial excision of the medial triceps (1 case each). Collected data included patient-reported outcomes, visual analog scale pain score at rest and during physical activity and radiographic assessment of arthritis and prosthesis loosening.
Average clinical follow-up was 8 years (range: 3 to 13). All 5 patients were pain-free at rest, and 3 reported moderate elbow pain (visual analog scale: 5 to 6) with physical activity. At an average radiographic follow-up of 3 years (range: 0.5 to 5), 3 patients showed mild progression of elbow arthrosis, but there were no signs of progressive capitellar erosion or implant loosening. Only 1 complication was noted-development of heterotopic ossification in 1 patient, which required open heterotopic ossification excision and contracture release 2 years following the RHA. None of the patients required prosthesis revision or removal.
RHA was successful in improving pain and axial forearm stability in this very small series of adolescent patients. Concerns regarding long-term longevity and complications still exist. Considering the lack of other reliable treatment options, RHA may be indicated in this challenging patient population.
Level IV: therapeutic study-case series.
在年轻患者中，严重的放射头关节病变的治疗具有挑战性。桡骨头置换术（RHA）是成人的一种治疗选择，但大多数外科医生避免在年轻患者中实施，并且对于 16 岁以下的患者没有发表的结果。
我们的回顾性队列描述了 5 名患者（4 名男性，1 名女性），他们在平均 14 岁（范围：13 至 15 岁）时接受了非骨水泥模块化 RHA。术前诊断为创伤后放射头关节不匹配和关节炎，因为 3 例患者有以前的 Salter-Harris 3 或 4 型桡骨头骨折；2 例患者因桡骨头切除术后前臂轴向不稳定。由于这些病例的肘部病理学复杂，所有患者均接受了联合手术，包括：挛缩松解（5 例）、矫正尺骨截骨术（2 例）、尺骨远端缩短截骨术、桡尺骨融合切除、肱骨小头微骨折和内侧三头肌部分切除（各 1 例）。收集的数据包括患者报告的结果、休息时和活动时的视觉模拟量表疼痛评分以及关节炎和假体松动的放射学评估。
平均临床随访 8 年（范围：3 至 13 年）。所有 5 名患者在休息时均无痛，3 名患者在活动时报告中度肘部疼痛（视觉模拟量表：5 至 6）。在平均 3 年的放射学随访（范围：0.5 至 5 年）中，3 名患者显示出轻度进展性肘关节炎，但没有发现进行性肱骨小头侵蚀或假体松动的迹象。仅注意到 1 种并发症-1 例患者发生异位骨化，在 RHA 后 2 年需要进行开放异位骨化切除和挛缩松解。没有患者需要进行假体翻修或取出。
在这个非常小的青少年患者系列中，RHA 成功地改善了疼痛和轴向前臂稳定性。对长期寿命和并发症的担忧仍然存在。考虑到缺乏其他可靠的治疗选择，RHA 可能适用于这个具有挑战性的患者群体。
IV 级：治疗性研究-病例系列。
