The value of elbow arthroscopy in diagnosing and treatment of radial head fractures
Abstract Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy,...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12891-019-2726-6 |
| _version_ | 1818851274860265472 |
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| author | Florian Haasters Tobias Helfen Wolfgang Böcker Hermann O. Mayr Wolf Christian Prall Andreas Lenich |
| author_facet | Florian Haasters Tobias Helfen Wolfgang Böcker Hermann O. Mayr Wolf Christian Prall Andreas Lenich |
| author_sort | Florian Haasters |
| collection | DOAJ |
| description | Abstract Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% (p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% (p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% (p < 0.001) of the CR and in 18% (p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% (p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14. |
| first_indexed | 2024-12-19T07:02:26Z |
| format | Article |
| id | doaj.art-5c50d6e1eb29453a8a370e21d3dfdd54 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-19T07:02:26Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-5c50d6e1eb29453a8a370e21d3dfdd542022-12-21T20:31:22ZengBMCBMC Musculoskeletal Disorders1471-24742019-07-0120111010.1186/s12891-019-2726-6The value of elbow arthroscopy in diagnosing and treatment of radial head fracturesFlorian Haasters0Tobias Helfen1Wolfgang Böcker2Hermann O. Mayr3Wolf Christian Prall4Andreas Lenich5Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU)Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU)Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU)Department of Orthopaedics and Traumatology, Freiburg University Hospital, Albert-Ludwigs-University of FreiburgHospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU)Department of Orthopedic Sports Medicine, University Hospital Rechts der Isar, Technical University MunichAbstract Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% (p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% (p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% (p < 0.001) of the CR and in 18% (p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% (p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.http://link.springer.com/article/10.1186/s12891-019-2726-6Radial head fractureArthroscopyAssociated injuryElbow dislocationArthroscopic assisted fracture treatment |
| spellingShingle | Florian Haasters Tobias Helfen Wolfgang Böcker Hermann O. Mayr Wolf Christian Prall Andreas Lenich The value of elbow arthroscopy in diagnosing and treatment of radial head fractures BMC Musculoskeletal Disorders Radial head fracture Arthroscopy Associated injury Elbow dislocation Arthroscopic assisted fracture treatment |
| title | The value of elbow arthroscopy in diagnosing and treatment of radial head fractures |
| title_full | The value of elbow arthroscopy in diagnosing and treatment of radial head fractures |
| title_fullStr | The value of elbow arthroscopy in diagnosing and treatment of radial head fractures |
| title_full_unstemmed | The value of elbow arthroscopy in diagnosing and treatment of radial head fractures |
| title_short | The value of elbow arthroscopy in diagnosing and treatment of radial head fractures |
| title_sort | value of elbow arthroscopy in diagnosing and treatment of radial head fractures |
| topic | Radial head fracture Arthroscopy Associated injury Elbow dislocation Arthroscopic assisted fracture treatment |
| url | http://link.springer.com/article/10.1186/s12891-019-2726-6 |
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