The Effect of an Associated Monteggia or Transolecranon Fracture Dislocation on Outcomes of Radial Head Arthroplasty.

Abstract

The purpose of this study was to compare the clinical outcomes, radiographs, and complications of radial head arthroplasty in patients with concomitant Monteggia or transolecranon fracture dislocations to patients with isolated radial head fractures. A retrospective cohort comparison was performed, identifying unreconstructible radial head fractures that were treated with radial head arthroplasty. Patients >18 years of age with at least 1 year of follow-up were included. Patients with Monteggia or transolecranon fracture dislocations were matched by age (within 5 years), sex, and smoking status to patients with isolated radial head fractures for comparison. Outcome measures included range of motion, patient-reported outcome scores, complications, and reoperation rates. A total of 58 patients with a Monteggia (n = 38) or transolecranon fracture dislocation (n = 20) met the inclusion criteria and were matched to 58 patients with isolated radial head fractures. Clinical outcomes were similar across all three groups in range of motion and patient-reported outcome scores. There were significantly more complications and reoperations in the Monteggia and transolecranon fracture dislocation groups compared with the isolated radial head fracture group. Functional stiffness (flexion less than 30°-130°) and hardware irritation were more common in the Monteggia and transolecranon groups. Additionally, a higher incidence of ulnohumeral arthritis was identified in patients with transolecranon fractures (grades 3-4, 25%). There were similar functional outcomes achieved in patients who underwent radial head arthroplasty in Monteggia and transolecranon fracture dislocations compared with isolated radial head fractures. The Monteggia and transolecranon groups had a higher incidence of complications and higher rates of reoperation, specifically hardware irritation and elbow stiffness requiring removal of hardware (proximal ulna plate) and contracture release, respectively. Prognostic IV.