Prosthesis after comminuted radial head fractures. Midterm results

Background. For many years, resection was the only therapy used for comminuted fractures of the radial head. When associated with an injury of the collateral ligament, the outcome was often unsatisfactory. Implantation of the modern radial head prosthesis promises a better outcome. Methods. Between June 2001 and January 2005, 30 patients were treated with a modular metallic radial head arthroplasty; 28 patients were available for follow-up. Their mean age was 49 years. The patients were followed for an average of 29 months. The outcomes were assessed on the basis of pain, motion, radiographic findings, and grip strength as measured with the Jamar Dynamometer. The overall outcome was rated using a pain visual analog scale, and the scoring systems described by Radin and Riseborough and by Broberg and Morrey. Results. 19 patients achieved excellent or good results, 8 had fair results, and 1 had a poor result as based on the Morrey score. 22 patients showed periprosthetic osteolysis on radiologic examination. Conclusion. Arthroplasty with a modular metallic radial head combined with ligament reconstruction is an effective alternative to radial head resection. Compared with resection, the results using the EVOLVE (R) prosthesis demonstrate definite advantages with regard to clinical outcome.