The Wrightington approach to the radial head: biomechanical comparison with the posterolateral approach

The Wrightington approach to the radial head involves elevating anconeus from the proximal ulna to expose the supinator crest and then osteotomizing the bony insertion of the lateral ligament complex to the ulna. This avoids incising through the substance of the lateral ligament complex. The purpose of this study was to determine if there is any difference in laxity changes between using the posterolateral versus the Wrightington approach in performing surgery upon the radial head in a cadaveric model.

Ten cadaveric elbows had a radial head fracture created and the medial collateral ligament divided. They then sequentially had the posterolateral or Wrightington approach to the radial head, fracture fixation, head excision, and replacement. After each step, valgus and varus laxity and ulnar rotation were determined with an electromagnetic tracking system.

After each step, there was a greater increase in valgus and varus laxity in the posterolateral group compared with the Wrightington group. After surgical exposure, radial head fracture fixation, and radial head excision, there was a statistically significant difference in the changes in rotation between the posterolateral and Wrightington approaches, with the former resulting in an increase in external and the latter an increase in internal rotation.

These results suggest that the newly described Wrightington approach is biomechanically superior to the posterolateral approach with regard to changes in elbow laxity after surgery to the radial head.