Radial Head Replacement BEST EVIDENCE
Hitesh GopalanClinical Asst Professor.
www.orthoevidence.comwww.orthopaedicprinciples.com
Radial HeadValgus stabiliser
Axial Stabiliser
60% of load transfer
ProblemsComminutionLUCL injuryMCL injuryElbow DislocationCoronoid fractureEssex Lopresti Injury(ALRUD)
Ligamentous Instability
Treatment OptionsConserveFixationExcisionPartial excisionReplacement
GuidelinesMason 1: Conservative
Mason 2: Fix
Mason 3 and 4: Fix with ligamentous repair, Replace or Partially Excise?
Ligamentous Instability
When ReplaceMason type 3 fractures
Associated ligamentous injuries(ALRUD)
Complex injury(Terrible triad)
Replace Vs FixationThree or more fragments
Impaction
Significant metaphyseal bone loss
Radial Head ExcisionChronic ulnar wrist pain, InstabilityElbow stiffness, Proximal radial migration 2-3
mmLoss of strength, Degenerative arthritisCubitus valgus, Heterotopic calcificationMyositis ossificans, Radial tunnel syndromeSynostosis, Ulnar neuropathy
Clin Orthop Relat Res. 1998; 353:40-52.
Radial Head Replacementmonoblock metalpress-fit and ingrowth stems,cemented stems, bipolar , and ceramicFloating Radial head prosthesis(Tornier, Fr)
Acrylic, silicone rubber, cobaltchromium Alloy, titanium
Osteochondral autografts(Han KJ 2012)
What’s the EvidenceLevel 4
Level 3
Level 2
No level 1 randomised trial that compares radial head replacement with fixation
Replacement –Level IVMoro et al.. El Sallakh S (J Orthop Trauma 2012)Shore et al(JBJS A-2008)
Excellent to Good Results in 80%
Less reports on complications like loosening, wear
Level 3Retrospective Case control designComplex InjuriesFixation (13)Vs Replacement(11)Outcomes: ASES , DASH scores
Better functional outcomes with Replacement
•Radial head replacement: 14 patients•Radial head repair: 8 cases•Level: IV•Outcome assessment: Broberg and Morrey scale•92. 9% satisfactory results in replacement group Vs 12.5 % satisfactory results in fixation group
Replacement: 22 patientsRepair: 23 patientsOutcomes: Broberg and Morrey SystemAnalysis: Satisfactory outcome in 91% in replacement group Vs 65% in ORIFLevel 2 Randomised Trial
Xiao Chen et al..Int Orthop 2011
ReplacementAccurate Sizing and length
Avoid overstuffing the joint
Damage to articular cartilage of capitellum
Level IV retrospective case series(n=32)MyoPC ProsthesisOutcomes: Broberg and Morrey, Mayo Elbow PerformanceSatisfactory Outcomes
Radial head FracturesUndisplaced(Mason 1): Conservative with
early mobilisation
Comminuted: Elderly- EXCISION
Radial HeadMason 2: one or two fragments, dense bone:
Fix
Mason 3-4: Replace
Thank You