دانلود رایگان مقاله آرتروسکوپی شعاعی قطع و برداشت ایمپلنت سر

Abstract

Displaced radial head fractures are treated with open reduction and internal fixation using implants. Failure of fixation may occur in the presence of comminution and in multifragmentary fractures; open surgical approaches are necessary for removal of the implants and radial head resection. Arthroscopic radial head resection has been described as a minimally invasive and effective treatment for failed radial head fracture fixation; however, periarticular adhesions and prominent implants add to the complexity and technical difficulty of the procedure. The described technique uses 3 portals for adhesiolysis, implant removal, and radial head resection. Resection is performed in stages; smaller-diameter instruments are used to gain and improve access, and larger resectors are used subsequently. Adequacy of resection is assessed arthroscopically and with biplanar imaging. The arthroscopic technique avoids the need for an open surgical approach and prevents subsequent morbidity. In addition, the rehabilitation time is shorter and patient satisfaction is high.

Discussion

Arthroscopic radial head resection has been described before, and the results of this procedure have been comparable with those of the traditional open surgical approaches.10-13 Wijeratna et al.13 evaluated 15 patients who underwent arthroscopic radial head excision for elbow trauma; they suggested that the arthroscopic technique had similar results to open excision and was safe and reliable. Menth-Chiari et al.12 analyzed the outcomes of arthroscopic radial head excision in 12 patients with post-traumatic arthritis or rheumatoid arthritis; they found that the procedure was effective in relieving elbow stiffness and pain. Similarly, Bornu et al.3 reported good outcomes of arthroscopic release and radial head resection in 12 patients with elbow joint arthritis. Arthroscopic resection of the radial head is a difficult procedure with a steep learning curve. Capsular hypertrophy and intra-articular adhesions that occur from previous extensive surgery result in elbow stiffness, and this reduces the intra-articular working space for resection. The presence of fixation implants adds to the technical difficulty; these implants need meticulous removal before resection to avoid the risk of losing the implant in the deeper recesses of the complex anatomy of the elbow joint. The technical steps described in this report permit minimally invasive implant removal and bone resection. In addition, the adhesiolysis described is crucial to achieving the desired improvement in range of motion and pain relief. The overall advantages and pitfalls of the procedure are summarized in Table 3.