Displaced Fractures of the Radial Head: Internal Fixation or Excision?

Comminuted Radial Head Fractures Treated with Pyrocarbon Prosthetic Replacement

“…The mean time between the injury and the surgery was 3 days (0-7 days). Radial head fractures were classified according to the system proposed by Hotchkiss [11]. Pain at rest and during activity was measured with a visual analog scale (VAS).…”

“…With the patient placed in the supine position under axilar anesthesia, we used the extensile lateral approach, which was defined by Hotchkiss [11] through the lateral collateral ligament (LCL) and common extensor muscles to expose the radial head in all patients. After the arm was positioned, a long Kocher lateral approach was made beginning at the lateral epicondyle and ending distal to the radial neck.…”

“…Acute axial instability resulting from radial head fracture and disruption of the interosseous ligament and triangular fibrocartilage complex (TFCC) has been well described and defined as the Essex-Lopresti injury. Chronic axial instability after radial head excision without apparent interosseous ligament or TFCC instability and the resultant symptomatic proximal migration of the radius is less well understood but has been reported to range from 20% to 90% [11]. Radial head arthroplasty is indicated in unreconstructable head fractures and in cases of associated elbow instability for which excision of the radial head likely will produce late complications.…”

“…First, it serves as a secondary stabilizer to valgus instability of the elbow, with the primary stabilizer being the medial collateral ligament (MCL). Second, the radial head also provides stability to the distal radial ulnar joint to assist the forearm in resisting axial forces and enhancing grip strength [11,16]. In the presence of an intact MCL, radial head excision does not appear to result in cubitus valgus or late medial elbow instability [16].…”

Radius head fractures in adults and children

“…In jüngsten Veröffentlichungen wurde berichtet, dass der Radius bis zu 80% der Belastung des Handgelenks auf nimmt, sich diese jedoch bis zum Ellen bogen gegenüber der Ulna auf die Hälfte ausgleicht [14,27].…”