Subchondral Shelf Support Plating for Impacted Radial Head Fractures: Surgical Technique and Case Series

Subchondral bone impaction at the level of the radial neck, usually present at the anterior or lateral quadrant, can be an associated feature in radial head fractures. Buttress plating principles suggest that subchondral zones of impaction are best supported by an implant positioned directly on the site of impaction to resist secondary collapse. The anatomical considerations limit the standard radial head plating technique to a narrow safe zone. Therefore, irrespective of the zone of impaction, the standard plating zone remains the same, which may not provide the best possible mechanical construct for radial head fractures where the zone of impaction lies outside the safe zone for plating. In this study, the authors present an alternate subchondral shelf plating technique performed through the zone of impaction. The technique involves supporting the disimpacted radial head using a bent mini-fragment plate that acts as a shelf along with supplemental fixation. The shelf plate remains extra-articular, recessed below the radial head and the proximal radioulnar joint, with scope for impingement-free fixation along the entire circumference of the radial head. The technique was used in 13 adult patients and yielded excellent outcomes. Radiological healing was achieved in all patients with maintenance of reduction. The mean Mayo Elbow Performance Score and the quick DASH score were 96.5 ± 6.5 and 4.9 ± 3.3, respectively, at a mean follow-up of 20 ± 8 months.