Is a Silastic Radial Head Still a Reasonable Option?

Abstract

Background The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of ''overstuffing,'' cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial. Questions/purposes We asked whether intact or reconstructed primary elbow stabilizers permit use of silastic radial head implants without fragmentation, failure, and silicone synovitis. Methods We retrospectively reviewed 23 patients with unreconstructable radial head fractures who were treated with silastic radial head arthroplasty and concomitant repair and/or reconstruction of the medial ulnar collateral ligament and/or lateral ulnar collateral ligament. Analysis included range of motion, pain, stability, and radiographic assessments; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; and Mayo Elbow Performance Score (MEPS). The minimum followup was 16 months (average, 69.6 months; range, 16-165 months). Results At last followup, the mean elbow flexion was 145°, extension 11°, supination 80°, and pronation 83°. The mean MEPS score was 88.9. The mean DASH score was 11.8. There were eight reoperations, none resulting from failure of the radial head implants. Conclusions These results demonstrate silastic radial heads can be used with low complication rates and without evidence of synovitis when concomitant elbow ligament repair or reconstruction is performed.

Resection Arthroplasty for Mason Type III Radial Head Fractures Yield Good Clinical but Poor Radiological Results in the Long Term

“…Despite achieving satisfactory clinical outcomes, performing radial head resection arthroplasty as the initial method for treating Mason type III radial head fractures is no longer acceptable, especially in view of the latest encouraging studies on ORIF and radial head arthroplasty for this type of fracture. 2,[8][9][10][18][19][20] The possibility of proximal migration of the radius and an increase in the carrying angle also must be considered. Osteoarthritic changes in both the elbow and wrist are frequent radiographic consequences of the excision procedure; however, these complications often are without functional impairment.…”

“…[2][3][4][5]7,[18][19][20] Fragment number of the fracture, amount of displacement, impaction, bone quality, and associated fractures and ligament injuries must be considered when formulating a treatment strategy. 5 As fractures become more comminuted and displaced, the method of treatment also becomes more challenging.…”

“…Open reduction and internal fixation, resection arthroplasty, or radial head implant arthroplasty are the most advocated treatment options for Mason type III fractures, yet the ideal method continues to be a subject of debate. [2][3][4][5]8,9,[11][12][13]18,19,21,22 Resection arthroplasty has been recommended by numerous studies for Mason type III radial head fractures, especially fractures with no concurrent ligament insufficiency or when stable osteosynthesis cannot be achieved. [3][4][5][6][7]11,[14][15][16][17]23 Many studies do not advocate radial head excision because of its high rate of complication, including pain, varus-valgus and posterolateral rotatory instability, heterotopic ossification, proximal radial migration, cubitus valgus and associated ulnar nerve symptoms, and elbow and wrist arthritis; instead, these studies suggest radial head preservation if possible or replacement when necessary.…”

Surgical Treatment of Radial Head Fractures: Review of Literature.

“…These complications and biomechanical studies showing the inability of silicone implants to support the radius functionally have lead to their disuse [19]. However recently other authors have argued that the silastic implant can be used in a stable elbow with good functional and radiographic results [40]. Therefore Boulas' paper [33] has been included in this systematic review.…”

Functional Outcomes of Fixation Versus Replacement for Comminuted Radial Head Fractures in Adults: A Systematic Review

“…These complications and biomechanical studies showing the inability of silicone implants to support the radius functionally have lead to their disuse [19] . However recently other authors have argued that the silastic implant can be used in a stable elbow with good functional and radiographic results [40] . Therefore Boulas' paper [33] has been included in this systematic review.…”