Indications for Radial Head Replacement Following Elbow Trauma

, Loyola University Medical Center, Maywood, Ill.; , former Director of Nursing, San Joaquin Surgical Center, Fresno, Calif.

Disclosures

Medscape General Medicine. 1997;1(2) 

In This Article

Abstract and Introduction

Abstract

Radial head fractures are frequently caused by trauma to the elbow. While the average length of time of disability following these injuries is 8.5 weeks, significant permanent disability may persist. Radial head replacement is indicated in displaced or comminuted fractures or when a perfect reduction cannot be accomplished with open reduction and internal fixation (ORIF). Contraindications to replacement include open physes, inadequate radius bone stock, active infection, and deformity of the proximal radio-ulnar joint. Other treatment options for radial head fractures include radial head removal, nonoperative splinting and early motion, or open reduction and internal fixation. Silastic implants, one choice of prosthetic material, are especially useful in treating elbow instability due to associated elbow dislocation or acute distal radio-ulnar joint dislocation (DRUJ). Three illustrative cases and a review of the literature is presented.

Introduction

Radial head fractures comprise 5.4% of all adult fractures and 33% of elbow fractures.[1] Mason's classification[2] system is employed to categorize the severity of fractures and assist in determining appropriate treatment. According to this system, type I fractures are undisplaced, type II fractures are displaced, and type III are comminuted (Table I).[1,3] The treatment for type I fractures is usually nonoperative.[3,4,5] Most investigators suggest open reduction internal fixation (ORIF) for the treatment of types II and III,[1,5,6,7,8,9,10] whenever possible. Good results are also reported following complete radial head excision,[4,11,12,13] nonoperative treatment,[3,14,15,16] and radial head replacement.[17,18,19,20,21,22,23,24] While the average disability following displaced radial head fractures is 8.5 weeks, significant disability can be of longer duration.[11] In this article, we present three case studies in which silastic radial head replacement was the preferred therapy and review the current indications for this procedure.

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