Radial Head Fractures Save or Replace?
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1 Radial Head Fractures Save or Replace? Current Solutions in Orthopedic Trauma Sepember 19, 2015 Jorge L. Orbay MD. Disclosure Skeletal Dynamics Elbow Joint Ulno-Humeral and Radio-Capitellar The key joint in the upper extremity Shoulder r 1
2 Elbow Ulno-Humeral and Radio-Capitellar The key joint in the upper extremity R Elbow Ulno-Humeral and Radio-Capitellar The key joint in the upper extremity Elbow Ulno-Humeral and Radio-Capitellar 2
3 Elbow Ulno-Humeral and Radio-Capitellar The key joint in the upper extremity 140 Flexion - Extension 180 Pronation - Supination Elbow Ulno-Humeral and Radio-Capitellar The key joint in the upper extremity 140 Flexion - Extension 180 Pronation - Supination Flexion - Extension Pronation - Supination Dysfunctional Elbow Stiffness / Instability 3
4 Dysfunctional Elbow Stiffness / Instability Elbow stiffness is a common complication even after low energy injuries. Elbow Trauma Proximal to the joint line - Humeral fracture Elbow Trauma Distal to the joint line 4
5 Elbow Trauma Distal to the joint line - Fracture radius / ulna - Ligament injuries Radial Head Fractures Mason Classification: Radial Head Fractures Type 1 (Non-Displaced) 5
6 Radial Head Fractures Type 2 (Shear) Radial Head Fractures Type 2 (Shear) 6
7 Radial Head Fractures Type 2 (Shear) Radial Head Fractures Type 2 (Shear) Radial Head Fractures Type 3 (Complete articular) 7
8 Radial Head Fractures Type 3 (Complete articular) Resection Radial Head Fractures Simple Inexpensive Resection Radial Head Fractures Abnormal biomechanics: Loss of motion - supination & extension 20% weakness of prono-supination 10% loss of elbow flexion torque 8
9 Radial Head Fractures Type 3 (Complete articular) + Variance Radial Head Fractures Type 3 (Complete articular) Osteoarthritis Radial Head Fractures Type 3 (Complete articular) RU Impingement 9
10 Radial Head Fractures Type 3 ORIF Radial Head Fractures Type 3 ORIF Radial Head Fractures Type 3 ORIF 10
11 ORIF ORIF ORIF 11
12 ORIF ORIF ORIF 12
13 ORIF Type III Radial Head Fracture 50% Failure Rate: 1- Avascular Necrosis 2- Non Union Surgical Approach Kocher 13
14 Kaplan Safety Zone 14
15 Radial Head Fractures Type 3 Replacement Radial Head Fractures Reproducible Cost Replacement 15
16 Measuring Head Diameter 16
17 Measuring Neck Cut Reaming 17
18 Approach medullar canal in pronation Trialing 18
19 Trialing Prevent Overstuffing 19
20 Radial Head Fractures Variable long term results: Loosening / migration Capitelar erosion Need for removal Radial Head Replacement: Spacer 20
21 Radial Head Replacement: Spacer Hemiarthroplasty - Radio-Capitelar Joint - PRUJ Radio-Capitelar force Radio-Ulnar force 21
22 Loosening Capitelar Erosion 22
23 Radial Head Kinematics 6 deg. off Radial Head Kinematics Radial Head Kinematics 23
24 Radial Head Kinematics Radial Head Kinematics 24
25 Long Stem = 3 Point Fixation 25
26 26
27 27
28 Radial Head Fractures Type 4: Dislocation Terrible Triad Ulna Fracture Essex Lopresti Radial Head Fractures Type 4: Dislocation 28
29 Radial Head Primary restrain to axial load on the radius Primary restrain to valgus strain on the elbow joint. A functional radial head will restore stability to the elbow with a type I or II coronoid fracture Posterior dislocation Radial head fracture Coronoid fracture Lateral ligament repair Radial head repair or replacement Coronoid repair for type II and III 29
30 Lateral ligament repair Radial head repair or replacement Coronoid repair for type II and III Elbow stabilization Coronoid Fracture Classification 30
31 Severe Instability 31
32 32
33 33
34 34
35 Radial Head and Proximal Ulna Fx 35
36 36
37 Essex-Lopresti Lesion Radial Head Fracture Essex-Lopresti Lesion Proximal Migration Radius Essex-Lopresti Lesion PIOL and DIOL prevent over-lengthening 37
38 Essex-Lopresti Lesion PIOL and Radial DIOL head prevent supports over-lengthening graft Essex-Lopresti 38
39 39
40 40
41 41
42 6 months F/U 6 months F/U 42
43 Conclusions Treatment of type 1 radial head fractures is usually early motion Conclusions Treatment of type 2 radial head fractures must be individualized: 1- Early motion 2- ORIF / HCS Conclusions Treatment of type 3 radial head fractures must be individualized: 1- Resection 2- ORIF 3- Replacement 43
44 Conclusions Radial head replacement is more reliable for fractures with 3 or more fragments. Conclusions Radial head replacement is succeptible to mechanical problems. Conclusions ORIF of displaced type III radial head fractures is technically demanding and succeptible to non union and AVN. 44
45 Conclusions Treatment of type 4 radial head fractures requires addressing concomitant instability 1- Elbow stabilization 2- IOL reconstruction Thank You! 45
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