Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47

Abstract

Introduction: Radial head fractures represent 33-75% of elbow fractures (30 cases/100,000 population/year). "Terrible triad's Hotchkiss" is characterized by radial head fracture, coronoid fracture and elbow dislocation. Our principal goal is to compare our results on each type of prosthesis in the context of the triad.

Material and methods: We conducted an observational, descriptive and retrospective study. Sample size was 47 patients. Variables analyzed were affiliation, Mason's classification, surgical aspects (moment of surgery, surgical time, prosthesis type, re-surgery), rehabilitation time, causes of prosthetic failure, complications, radiographic findings (according to van Riet), Popovic's loosening areas, MEPS and Cassebaum's scales. We performed an inter-group study, on patients treated with monopolar or bipolar prosthesis, in order to see results.

Results: Average age was 43.5±8.9 years. 72.7% were in highly demanding jobs. Mason's fracture type iv appeared in all the cases and Regan-Morrey's type I was the most frequent coronoid fracture (42.6%). There were 22 bipolar prosthesis and 25 monopolar prosthesis. Surgery time was about 112.3±59.1minutes. External fixation was used in 6.4%. MEPS final: 85.9±15 points. Rehabilitation time was about 4.7±2.5 months. Of the patients, 76.6% returned to work. Cassebaum's results were good-excellent in 74.5% of patients. There were 3 cases of prosthetic mobilization. Heterotopic ossification appeared in 29.8% of cases and 15.2% presented overstuffing. With regard to the inter-group study, we observed that there was less surgical time with monopolar prosthesis (P=.006), fewer second look surgeries (P=.05), less stiffness (P=.04), less heterotopic ossification (P=.004) and septic loosening (P=.005), without any influence on MEPS (P=.44).

Conclusions: Results obtained in terrible triads with prostheses in our experience are good. Prosthetic type influences results, because surgical time for implantation of a monopolar prosthesis was less than for a bipolar one, although rehabilitation time was longer. With bipolar prostheses, external fixation was required, with a higher rate of reinterventions, stiffness, prosthetic mobilization, heterotopic ossification and prosthetic loosening. However, there were no differences between the 2prosthetic types in terms of clinical results, like MEPS or Cassebaum scores.

Keywords: Arthroplasty; Artroplastia; Codo; Elbow; Prosthesis; Prótesis; Terrible triad; Triada terrible.