The Radial Floating Cup radial head prosthesis to treat radial head fractures: functional and radiographic results after more than 12 years of mean follow-up.

INTRODUCTION: This study was performed to evaluate the long-term clinical and radiographic results of patients presenting with a radial head fracture who were treated surgically with a Judet Radial Floating Cup 2 (RFC 2) radial head prosthesis.

MATERIALS AND METHODS: This was a retrospective, monocentric, observational, multi-operator, and continuous study performed between July 1997 and June 2009 on the treatment of radial head fracture using an RFC 2 radial head prosthesis. The primary efficacy endpoint was the functional status of the operated elbow, evaluated using the Disability of Arm-Shoulder-Hand (Quick-DASH) score and the Mayo Elbow Performance Index (MEPI). The secondary endpoints were mobility and stability of the operated elbow, residual pain and grip strength, nature and rate of complications, as well as possible radiographic abnormalities during follow-up.

RESULTS: Twenty-two patients were treated with the RFC 2 for radial head fractures over the study period. Three (13.6%) were lost to follow-up, including one death. Of the remaining 19 patients, three RFCs had to be removed (15.8%). The final analysis involved 16 patients. The mean follow-up was 144 months (range 109-225 months; standard deviation [SD] = 49.9 months) or 12 years. The average Quick-DASH score was 23.01/100 (range 0-50; SD = 7.8) and three cases were rated as having "excellent" results according to the MEPI (18.7%), nine cases were rated as having "good" results in (56.2%), and four cases were rated as having "average" results (25%). The average mobility values were: 132° of flexion (range 120°-150°; SD = 11), 14.5° of extension deficit (range 0°-40°; SD = 5), 84.4° of pronation (range 20°-90°; SD = 8°), and 67.7° of supination (range 25°-85°; SD = 10). All patients had a stable elbow. The average grip strength on the affected side thus corresponded to 79% (range 44-100%; SD = 8.3%) of the grip strength on the healthy side. Four patients (25%) developed complications: three cases of algodystrophic syndrome (18.7%) and one case of early dislocation (6.2%). Radiographic evaluation revealed that there was a periprosthetic radio-lucencies in eight patients (50%), periarticular ossifications in 12 patients (75%), and lysis of the capitulum in two patients. There was no significant difference in MEPI ratings between patients with and without a periprosthetic radio-lucencies (P = 0.8018).

CONCLUSIONS: Our results indicated that using the RFC 2 prosthesis to surgically treat radial head fractures provides good long-term functional results, including satisfactory mobility and stability.