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Treatment of Radial Head Fractures with a Modular Metallic Radial Head Replacement
Robert Longstaffe1, Graham J W King2, Jonathan P Marsh1
1Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada.
Introduction:
Radial head arthroplasty with a smooth-stemmed metallic modular implant is a reliable treatment option for patients with acute unreconstructible radial head fractures, and good clinical outcomes may be expected beyond 5 years of follow-up (Video 1).
Step 1 Preoperative Planning:
Obtain a careful history and perform a physical examination along with appropriate imaging to facilitate appropriate treatment decisions.
Step 2 Operating Room Setup And Patient Positioning:
Perform proper operating room setup and patient positioning, as they are required to gain access to all affected structures around the elbow in a safe and efficient manner.
Step 3 Approach:
Make a midline posterior skin incision with development of a full-thickness lateral fasciocutaneous flap or use a direct lateral incision; the deep interval is determined on the basis of the integrity of the LCL.
Step 4 Radial Head Excision:
Remove and preserve all fragments of the radial head for implant sizing.
Step 5 Implant Sizing:
Implant a prosthesis that closely replicates the dimensions of the native radial head, which is the primary goal of the procedure.
Step 6 Stem Broaching:
Sequentially broach the canal until good cortical contact is achieved and undersize the definitive stem by 1 mm to allow implant movement within the canal and appropriate articulation with the capitellum.
Step 7 Insertion Of Trial Components And Final Radial Head Implant:
With the selected trial in place, assess the radial head diameter, height, and articular congruency.
Step 8 Closure And Repair Of The Lcl:
Ensure proper repair of the LCL as it is essential to maintaining or restoring elbow stability.
Step 9 Postoperative Protocol:
Postoperative rehabilitation depends on the status of the collateral ligaments.
Results:
In a review of the cases of 55 patients at a mean follow-up of 8 years after radial head arthroplasty with a smooth-stemmed modular metallic prosthesis, Marsh et al.9.
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