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Monobloc vs. Modular Radial-Head Arthroplasty for Complex Elbow Trauma: Long-Term Follow-Up and Comparative
Shai Factor1, Ron Gurel1, Daniel Tordjman1
1Hand Surgery Unit, Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
Journal of Personalized Medicine
|September 28, 2024
Summary
Modular radial-head arthroplasty (RHA) shows better long-term outcomes than monobloc implants for Mason Type 3 fractures. Patients experienced improved function and less implant loosening with modular designs.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Reconstructive Surgery
Background:
- Mason Type 3 radial head fractures are commonly treated with open reduction and internal fixation (ORIF) or radial-head arthroplasty (RHA).
- Radial-head arthroplasty (RHA) options include traditional monobloc and newer modular implants designed for anatomical fit.
- While short- to medium-term RHA outcomes are favorable, long-term comparisons between monobloc and modular implants are limited.
Purpose of the Study:
- To compare the long-term functional and radiographic outcomes of monobloc versus modular radial-head arthroplasty (RHA) for Mason Type 3 fractures.
- To evaluate differences in elbow pain, function, range of motion, implant loosening, and degenerative changes between the two implant types.
Main Methods:
- Retrospective review of patients undergoing RHA at a level I trauma center (2000-2011).
- Follow-up included physical examination, validated questionnaires (MEPS, DASH, ASES, VAS), and radiographic analysis.
- Comparison of outcomes between patients treated with monobloc (n=4) and modular (n=10) prostheses with mean follow-up of 15 and 12.4 years, respectively.
Main Results:
- The modular RHA group demonstrated statistically significant improvements in MEPS and DASH scores compared to the monobloc group.
- Physical examination revealed significantly better elbow flexion and extension in the modular group.
- Radiographic analysis indicated less implant loosening in the modular group, though degenerative changes and heterotopic ossification were noted, predominantly in the modular group.
Conclusions:
- Modular radial-head implants offer superior long-term functional outcomes and range of motion compared to monobloc implants for Mason Type 3 fractures.
- Modular implants may be a more favorable option for enhancing patient recovery and function after RHA.
- Further large-scale studies are warranted to confirm these findings and elucidate the long-term benefits of modular RHA.
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