Andrea Amura

Purpose Radial head fractures (RHF) plate fixation has been associated with chronic pain and stiffness. This study aimed to evaluate if the new generation of anatomic low-profile locking-plates (ALPLP) allows to obtain satisfactory results lowering the complication rate and the need for reintervention. Methods Fifty-seven patients treated with ALPLP for RHF were analyzed: 24 were Mason II fractures and 33 were Mason III fractures. Post-operative and follow-up radiographs, range of motion and clinical scores (MEPS, DASH and ASES-e) were evaluated. Complications and reinterventions were recorded. The statistical analysis was performed using the ANOVA with post-hoc Tukey and Chi-squared test. Results The mean follow-up was 5 years. The mean ROM was 9°-140° in extension-flexion and 81°-81° in pronation-supination; the mean MEPS, DASH and ASES-E were 98, 3 and 93.9, respectively. Eight patients underwent reinterventions during follow-up, two patients developed asymptomatic nonunions. Significant differences were observed between Mason II and Mason III patients as for flexion and between patients who underwent “in situ” or “on table” reconstruction in terms of MEPS. Degenerative changes appeared to be significantly more frequent in RHF with involvement of the articular surface with respect to isolated neck RHF. Conclusion The main indications for osteosynthesis with ALPLP were a Mason II fracture with sinking of the head-neck junction and a multifragmentary Mason III fracture without radial neck comminution; with these indications, ALPLP provide satisfactory results in most cases, allowing to preserve the radial head in 96.5% of cases. The anatomical reduction of fracture, the sub-equatorial positioning of the plate in the “safe zone”, the reconstruction of the annular ligament without excessive tension and the early rehabilitation are the four main factors that affect results.

Introduction: This study aimed to quantitatively evaluate the effect of the trauma to surgery time interval (Tt-Ts) and the type of tendon retraction (unretracted vs. coiled) in distal biceps tendon ruptures (DBTRs) on the choice between primary tendon repair (PR) and tendon reconstruction with graft (RG). Materials and Methods: In total, 123 patients with surgically treated DBTRs were analyzed. Patients were divided into three groups: Group I—acute (75 patients with Tt-Ts < 21 days), Group II—subacute (20 patients with Tt-Ts between 21 and 45 days), and Group III—chronic (28 patients with Tt-Ts > 45 days). The type of surgical treatment (PR vs. RG) was evaluated in each group. The type of tendon retraction (unretracted vs. coiled) was analyzed in subacute and chronic lesions. A statistical analysis was performed. Results: The mean Tt-Ts interval in the overall sample was 59.3 days; in Group I, it was 9 days (range, 2–20); in Group II, it was 29 days (range, 22–42); and in Group III, it was 196 days (range, 45–1095). PR was performed in 100%, 90%, and 29% of the patients in Groups I, II, and III, respectively. Coiled tendons were found in 60% and 71% of patients in Groups II and III, respectively. Among patients with coiled tendons, 2 and 20 received RG in Groups II and III, respectively. The Tt-Ts and the type of retraction were significantly associated with the choice of surgical treatment (PR vs. RG), with statistical differences between Group III and the other two groups (p < 0.05). A cut-off of 43.5 days following injury was found to predict the need to perform RG with an accuracy, sensitivity, and specificity of 94%, 100%, and 92%, respectively. The likelihood of receiving RG rather than PR increased each day by 6%. Conclusions: Treatment delay significantly affects the choice of surgical technique in DBTRs. PR is feasible in 98% of acute and subacute ruptures, whereas RG is necessary in 70% of chronic ruptures. The type of tendon retraction affects the choice of treatment only in chronic lesions, as coiled tendons always require RG.

Assessment of progression and clinical relevance of stress-shielding around press-fit radial head arthroplasty