Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy.
, Via Emilia Est 380\1, Modena, 41124, Italy.
Arch Orthop Trauma Surg. 2024 May;144(5):2007-2017. doi: 10.1007/s00402-024-05305-6. Epub 2024 Apr 3.
In acute treatment of radial head fractures, a radial head prosthesis can be considered if open reduction and internal fixation are not technically feasible.
We reviewed the data of 27 consecutive bipolar Judet radial head prostheses implanted in patients with unreconstructable radial head fractures and no other concomitant fractures (coronoid or olecranon factures). The lesions of the lateral collateral ligament were rated according to the McKee classification. Twenty-three patients with more than ten-year follow-up participated in this retrospective study All patients underwent assessments for pain, range of motion and stability using the Mayo Elbow Performance Score, the QuickDash questionnaire and a Visual Analogue Scale for pain. Radiography assessment was performed to determine the correct setting of the implant, presence of periprosthetic loosening, prosthetic disassembly, heterotopic ossification, capitellum and ulnohumeral degenerative changes.
Mean follow-up was 149 months (± 12.2). Mean range of motion in flexion-extension was 111° (± 10.55), mean extension was 18° (± 14.32) and mean flexion was 130° (± 11.4). Mean arc of motion in supination-pronation was 150° (± 12.26). The mean Mayo Elbow Performance Score was 88, the mean QuickDash score was 7.3; 86% of the patients were satisfied. Seven patients (26%) required secondary surgery. The most frequent complication was heterotopic ossification, which had negative consequences on the functional result.
Bipolar radial head prostheses are an option for acute treatment of isolated unreconstructable radial head fractures. During follow-up, three patients required implant revision and removal; the capitellum surface presented severe degenerative changes and the prosthesis was not replaced. Another complication was the risk of implant dislocation, in relation to implant design, incorrect positioning of the radial head stem or else to inadequate reconstruction of the lateral collateral ligament. Further work is needed to establish the long-term follow-up results of Judet implants in complex elbow fractures.
在桡骨小头骨折的急性治疗中，如果无法进行切开复位内固定，则可以考虑桡骨小头假体。
我们回顾了 27 例连续使用双极 Judet 桡骨小头假体治疗无法重建的桡骨小头骨折且无其他伴发骨折（冠状突或鹰嘴骨折）的患者的数据。外侧副韧带损伤根据 McKee 分类进行评分。23 例患者随访时间超过 10 年，参与了这项回顾性研究。所有患者均使用 Mayo 肘关节功能评分、QuickDash 问卷和视觉模拟评分法（VAS）评估疼痛、活动范围和稳定性。影像学评估用于确定植入物的正确位置、是否存在假体松动、假体分离、异位骨化、肱骨小头和尺肱关节退行性改变。
平均随访时间为 149 个月（±12.2）。平均屈伸活动范围为 111°（±10.55），平均伸展为 18°（±14.32），平均屈曲为 130°（±11.4）。平均旋前-旋后活动范围为 150°（±12.26）。平均 Mayo 肘关节功能评分为 88 分，平均 QuickDash 评分为 7.3 分；86%的患者满意。7 例（26%）患者需要二次手术。最常见的并发症是异位骨化，这对功能结果有负面影响。
双极桡骨小头假体是治疗孤立性不可重建桡骨小头骨折的一种选择。在随访过程中，有 3 例患者需要进行翻修和取出假体；肱骨小头表面出现严重退行性改变，且未更换假体。另一个并发症是假体脱位的风险，这与假体设计、桡骨头柄的不正确定位或外侧副韧带重建不足有关。需要进一步研究以确定 Judet 假体在复杂肘骨折中的长期随访结果。
