Radial - Head Fractures. Christophe Spormann Endoclinic Zürich

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1 Radial - Head Fractures Christophe Spormann Endoclinic Zürich

2 Elbow Func6on > 90% Ac6vi6es of daily living : 100 Flexion Extension : Pro Supina9on : Extension deficit beeer tolerated than flexion deficit (Copeland,Gschwend, Landi, Shaffer: Dunitz, 1997, Morrey,B.F; 1990, JBJS 72A: )

3 Epidemiology Incidence: 2,5 2,8 / % of elbow fractures Peak incidence men: years Peak incidence women: years

4 Radial Head Func6on

5 Radial Head Func6on

6 Mechanism of Injury

7 Classifica6on - Radial Head Fractures Either coronoid or radial head fractured with axial load in extension Amis AA, Miller JH: Injury 26(3): ,1998

8 Classifica6on - Radial Head Fractures Simple (uncomplicated) Primary Classification Secondary Classification Complex (complicated) Fracture Type Mason Type I Type II Type III Mayo Classification, Saunders, 2000 Associated Injury Ligament Dislocation Mason IV MCL LCL Distal R-U Essex Lopresti Fracture Coronoid Olecranon

9 Classifica6on - Radial Head Fractures Morrey modified Mason Classification by quantifying displacement area > 30% and displacement > 2mm

10 Radial head fracture: MRI evaluation of associated injuries LUCL 13/24 54 % MCL 18/24 80% LUCL MCL 12/24 50% Osteochondral Lesion Capitellum Bone Bruise Loose bodies 7/24 29% 23/24 95% 22/24 91% Journal of shoulder and elbow surgery: John Itamura 2005

11 In the presence of an intact medial collateral ligament the radial head contributes 30 % of valgus stability, whereas in medial ligament disruption the radial head becomes the main constraint, contributing 60% of valgus stability

12 Type I - Radial Head Fractures 73% of all radial head fractures Mason ML. Br J Surg Most common radial head fractures De Muinck-Keizer et al., Orthopedics,2015 (38)

13 Type I - Radial Head Fractures Non-surgical : Splint 48h Early functional mobilization Ø 20% extension deficit Smits et al. Injury Aspiration and bupivacaine injection without benefit for undisplaced radial head fractures Chalidis, Papadopoulos et al. J Shoulder Elbow Surg Sep-Oct;18(5):676-9.

14 Type II - Radial Head Fractures 19% of all radial head fractures Mason ML. Br J Surg. 1954

15 Type II - Radial Head Fractures? Controversy: What fracture Type II needs surgery???

16 Type II - Radial Head Fractures No consensus: For isolated stable partial intraarticular fractures Kaas et al. J Hand Surg Am ORIF not superior to conservative treatment in the long terme Akesson et al. J Bone Joint Surg Am., 2006 Yoon, King et al. Clin Orthop relat Res. 2014

17 Type II - Radial Head Fractures If conservative treatment: Immobilization as for type I fractures Complications: Residual pain Loss of motion >40 % of complications Delayed excision of radial head Lindenhovius, Felsh, Ring, Kloen: J Trauma. 2009

18 Type II - Radial Head Fractures ORIF: Restore the anatomical shape Articular stability Kelbérine et al. Rev Chir Orthop, 1991 King et al. J Orthop Trauma, 1991 Heim, Trèb. Helvetica Chir Acta, 1978

19 Type II - Radial Head Fractures

20 Type II - Radial Head Fractures L.F., m, , left radial head fracture type II

21 Type II - Radial Head Fractures L.F., m, , left radial head fracture type II

22 Type III - Radial Head Fractures Comminutive fractures: Resection radial head only if stable medial elbow ORIF difficult to restore Ring et al. J Bone Joint Surg Am., 2002 Chen et al. Int Orthop, 2011

23 Type III - Radial Head Fractures ORIF: Resection: Replacement: Together with stabilization of the elbow Difficult to achieve If stable medial elbow Metallic stable Metallic bipolar Silicon

24 Type III - Fracture

25 Radial Head Resec6on

26 Radial Head Resec6on - Outcome

27 Radial Head Resec6on

28

29

30 Radial Head Replacement

31 Radial Head Replacement Goal: Restore joint line

32 Radial Head Replacement 35 Radial neck anatomic curve : ROM for full contact with capitellum

33 praeoperativ postoperativ 16 Mt 57 Mt

34 Failure - Radial Head Replacement Clinical reasons for failure of radial head prosthesis Pain 40 Stiffness 18 Instability 9 Infection 2 Radiographic Findings Implant related Loosening 31 Over-lengthening (over-stuffing) 11 Radial head subluxation 5 Component dissociation 3 JBJS br VOL. 92-B, No. 5, MAY 2010

35 Radial Head Replacement M.D.D., male, , Polytrauma 2014 Elbow: Flexion Extension: Pronation Supination:

36 Radial Head Replacement M.D.D., male, , Polytrauma 2014

37 Radial Head Replacement 6 months postop.: M.D.D., male, , Polytrauma 2014 Elbow: Flexion Extension: Pronation Supination:

38 Type III - Radial Head Fractures Displaced comminuted fractures Are the fragments large enough to allow internal fixation? If a plate is needed, can it be placed in a safe zone? Is the fixation stable to allow early mobilization? YES Internal Fixation of Fragments NO Radial Head Replacement

39 Tempora mutantur

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