Synopsis of Orthopaedic Trauma Management by Mullis Brian H.; Gaski Greg E.;

Author:Mullis, Brian H.; Gaski, Greg E.;
Language: eng
Format: epub
Publisher: Thieme Medical Publishers, Incorporated
Published: 2020-11-15T00:00:00+00:00

Fig. 26.6 Radial head arthroplasty with a lateral collateral ligament repair using a suture anchor.

Fig. 26.7 (a) Anteroposterior radiograph of an elbow following radial head arthroplasty. (b) Ulnohumeral joint incongruity (red) is seen due to radial head overstuffing. The radial aspect of the ulnohumeral joint has greater gapping than the ulnar side. (c) Lateral radiographic view of the same elbow—note the incongruity of the ulnohumeral joint also seen on this view.

E. Complications

1. Surgical approach—injury to PIN when working distal to the annular ligament.

2. Radial head excision—joint laxity, early arthritis at the ulnohumeral joint.

3. Radial head fixation—hardware penetration into radiocapitellar joint due to concave radial head anatomy or ulnohumeral joint if screws are too long.

4. Radial head replacement:

a. Large implants cause joint “overstuffing,” incongruity and early degenerative change.

b. Small implants can permit both longitudinal or valgus instability, and laxity due to suboptimal soft-tissue tensioning.

c. In a recent large literature review:

i. Overall revision rate for radial head arthroplasty is 8%.

ii. High rate of implant osteolysis (50% of press-fit stems).

iii. Most cases of osteolyses are asymptomatic.

iv. No discernible benefit to any particular type of implant material, means of stem fixation, or polarity of prosthesis.

F. Rehabilitation

1. Postoperatively, the elbow is splinted in 90 degree of flexion.

2. Early range of motion within a safe arc is determined by elbow stability in surgery.

3. When instability is present, patient’s elbow extension is blocked just short of point instability begins, and is gradually increased in 10 to 20 degree increments to full extension over several weeks.

4. Nonsteroidal anti-inflammatory drugs (NSAIDs) or radiation therapy may be used if the patient is thought to be at high risk of heterotopic ossification.

5. Radiation therapy and NSAIDs may increase risk of nonunion for fractures undergoing ORIF.

G. Outcomes

1. Results of poorly selected radial head excision show less strength, and worse function, compared to ORIF (except in a few select cases as discussed above).

2. Mason type II fractures treated with ORIF may have good-to-excellent functional outcomes.

3. Mason type III fractures treated with radial head arthroplasty may have good-to-excellent outcomes.

a. However, ORIF can have good-to-excellent outcomes in Mason type III fractures if stable anatomic reduction, articular congruity, and early motion protocol can be achieved.

b. Patient age, bone quality, number of fracture fragments, and presence of instability are all considerations when choosing to repair or replace the radial head.

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