Oskar radial head replacement is well developed for use in implant arthroplasty. Indications for radial head replacement following elbow trauma. The company voluntarily recalled more than 50,000 of the devices in late 2016 because of a flaw that could allow the radial stem to loosen. From radial head to radiocapitellar to total elbow. The radial head is an essential contributor to valgus, axial, and posterolateral stability of the elbow 2, 8, 12,14,15,16,17,18,19,20. Radial head prosthesis oskar radial head replacement. Matching precision of the reverse contralateral radial head. Isolated radial head fractures rockwood and green assume associated injuries unless proved otherwise 6. The goal of radial head replacement surgery is to replace the fragmented radial head at the elbow with a prosthetic one. Department of orthopaedics, the second xiangya hospital, central south university, changsha 410011, china. Radial head arthroplasty modern implants unipolar or bipolar, monoblock or modular, anatomical or nonanatomical, cemented or pressfit correct diameter, height, medial offset and cervicocephalic angle bipolarity permits an automatic positioning of the radial head with respect to the neck and the opposite.
Yan mingming,song deye,ding muliang,huang jun,ni jiangdong,wang junjie,xie hongming. The head of the radius has a cylindrical form, and on its upper surface is a shallow cup or fovea for articulation with the capitulum of the humerus. Intraoperative fluoroscopic assessment of proper prosthetic. Unlike total elbow arthroplasty, radial head replacement is most. Although numerous studies have described the outcomes of radial head fractures treated with metallic radial head replacements, most are smaller series with limited followup 28. After the initial experience with silastic implants, metallic or pyrocarbon arthroplasty have been used for 20 years. Failure of metal radial head replacement semantic scholar. Radial head arthroplasty aims to reconstruct the native head and is indicated when internal fixation is not feasible and in the presence of complex elbow injuries. Nov 14, 2016 lecture in ultrich netherlands 572016. As adequate function of the implant relies on correct size and position of the implant, the height of the osteotomy plays an important role as it determines the final radial length. Radial head prosthesis fracture arthroplasty complex elbow instability. Isolated radial head fractures davidson et al all 111 patients with entire radial head fractures had associated wrist or elbow ligamentous injury clin orthop 1993 30 70% associated injuries in various studies 5. Review article radial head replacement in adults with recent fractures. Of 14 patients, 12 with radial head prosthesis were available for the study.
Silicone implants, first introduced in the late 1960s, have fallen out of favor because of high rates of implant fracture and silicone synovitis 9, 10. Detrimental effects of overstuffing or understuffing with a. Sep 28, 2017 radial head arthroplasty with a smoothstemmed metallic modular implant is a reliable treatment option for patients with acute unreconstructible radial head fractures, and good clinical outcomes. Radial head fractures are fairly common 20% of all traumatic elbow injuries. The articular surface of the radial head prosthesis should be at the level of, or slightly proximal to the lateral edge of the coronoid articular surface.
Treatment of radial head fractures with a modular metallic. Radial head arthroplasty with a smoothstemmed metallic modular implant is a reliable treatment option for patients with acute unreconstructible. Overstuffing of the radiocapitellar joint is a frequent technical fault and has significant adverse effects on elbow biomechanics. For primary and revision joint replacement of the radial. The radial head is an important stabilizer of the elbow joint providing valgus and axial stability to the elbow and forearm. Radial head prosthesis surgical technique depuy synthes 1 radial head prosthesis system for primary and revision joint replacement of the radial head radial stems available in straight or curved option fluted design for rotational stability straight stem has beveled tip. Radial head fractures are frequently caused by trauma to the elbow. Read detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateralligament deficient elbow, journal of bone and joint surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. There was an embolism, more associated with a fracture of the hip, not the radial head. Ultimately, radiologists will encounter elbow joint replacements on a more routine basis. Radial head prosthesis system for primary and revision joint replacement of the radial head integrated connection screw captivated in head articulating dish dish depth grows 0. In a 2 year followup of patients with comminuted radial head fractures treated with replacement grewal et al 2006. Almost 10 percent of all elbow dislocations include a fracture of the radial head.
Never perform radial head excision in the young as it leads to ulnar overgrowth. Radial head prostheses are indicated for treatment of complex radial head fractures not amenable for fixation. Nov 24, 2016 isolated radial head fractures davidson et al all 111 patients with entire radial head fractures had associated wrist or elbow ligamentous injury clin orthop 1993 30 70% associated injuries in various studies 5. Radial head prosthesis surgical technique depuy synthes 1 radial head prosthesis system for primary and revision joint replacement of the radial head radial stems available in straight or curved option fluted design for rotational stability straight stem has beveled tip to facilitate insertion into the medullary cavity. Can ulnar variance be used to detect overstuffing after. Explor modular radial head trial reduction continued slide the slot located on the undersurface of the radial head along the ridge located on the proximal radial stem until the head is fully seated figure 10.
From radial head to radiocapitellar to total elbow replacement. We therefore hypothesized that overlengthening the radial head during radial head arthroplasty. Dec 01, 2004 read detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateralligament deficient elbow, journal of bone and joint surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Radial head prosthetic replacement wheeless textbook of.
Radial head fractures treated with modular metallic radial. Reference points for radial head prosthesis size request pdf. The important stabilizing role of the radial head is most pronounced in the setting of ligamentous incompetence, which often occurs in association with radial head fractures 31, 32. The effect of radial head replacement on terrible triad of elbow. If radial head was fractured also, ulnar entrapment can happen from a stretch injury. Maximizing outcomes in the treatment of radial head fractures. Previously radial head excision was a popular treatment, now it is being replaced by open reduction and internal fixation or radial head replacement. Complications of radial head prostheses springerlink.
Radial head resection versus arthroplasty in unrepairable. The first radial head arthroplasty was performed by speed in 1941. Elbow radial head replacement answers on healthtap. Moreover, the trauma itself along with the initial overstuffing of the radial head replacement and the neglected ligamentous instability may have largely contributed to the patients outcome. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. Mar 23, 2019 the radial head is an essential contributor to valgus, axial, and posterolateral stability of the elbow 2, 8, 12,14,15,16,17,18,19,20. Radial head replacement is indicated in displaced or comminuted fractures or when a perfect reduction cannot be accomplished with open reduction and internal fixation. Little is known about complications related to these implants. The outcomes of treatment with a smoothstemmed, monoblock ti. Following the radial head replacement, the surface mismatches between the implants and the morphological characteristics of the original proximal radius decreased contact areas and increased contact forces which is potential for the longterm articulating cartilage wear. To avoid lengthening and overstuffing of the radiocapitellar joint, or shortening and instability, the prosthesis should fit as follows. Indications comminuted radial head fractures not amendable to fixation 3 or more fragments.
Replacement of the radial head is usually reserved for severe fractures that are displaced or cannot be repaired with screws andor plates. Radial head replacement is considered only in type iii fractures for which anatomic reduction and stable internal fixation allowing early mobilisation would be difficult or impossible to achieve. The bipolar judet radial head prosthesis can be used in unreconstructable. Alternative therapy for mason type 3 radial head fracture is radial head replacement. To our knowledge, this is the first report in clinical use of this kind of prosthesis for the radial head fracture. Radial head replacement in adults with recent fractures. Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateralligament deficient elbow. Primary replacement after fracture of the radial head symptomatic sequelae after radial head resection contraindications bone musculature, tendons, or adjacent soft tissue compromised by disease, infection. Thus, the surgeon planning on treating a comminuted radial head fracture with orif should have arthroplasty implants available and be prepared to convert to radial head replacement in the face of.
Van glabbeek f1, van riet rp, baumfeld ja, neale pg, odriscoll sw, morrey bf, an kn. Complications of radial head fracture general center. Ct scan in sagittal view 10 months postoperatively revealing overstuffing with. If fractured elbow radial head is too badly displaced, or separated, it may not be able to be repaired and a radial head replacement may be necessary. It occurs when the upper arm bone and the ulna return to normal alignment and a piece of the radial head bone is then fractured or chipped off. One complication that is unique to radial head arthroplasty is overstuffing of the radiocapitellar joint space. With its precise design, it ensures the fulfillment of requirements of higher demand patients requiring. Sep, 20 overstuffing of the radiocapitellar joint during metallic radial head arthroplasty has been reported to cause loss of elbow flexion, capitellar erosion, and earlyonset osteoarthritis. Detrimental effects of overstuffing or understuffing with. Jun 26, 20 previously radial head excision was a popular treatment, now it is being replaced by open reduction and internal fixation or radial head replacement. The assessment of these common fractures and treatment have evolved with better understanding of the anatomy and biomechanics of radial head and the development of evidence based guidelines. Evolve proline modular radial head system wright medical group.
The depuy synthes radial head prosthesis system is a twopiece elbowjoint replacement device. In this situation, radial head replacement can be considered, as a means of. Overstuffing is a serious yet avoidable complication of radial head arthroplasty. Is the distal radioulnar variance useful for identification. The patientspecific implant created with 3d printing. Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multifragmented radial head fractures. Excision of the radial head without replacement was strictly avoided after the radial head was addressed, the hanging arm test. Although this is known, there is no agreedon measurement approach.
Although this is known, there is no agreedon measurement approach to determine whether overstuffing has occurred. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacement. Overstuffing of the radiocapitellar joint during metallic radial head arthroplasty has been reported to cause loss of elbow flexion, capitellar erosion, and earlyonset osteoarthritis. Due to overstuffing of the radial head prosthesis, capitellar erosion occurred and. Thus, radial head replacement is an alternative to a challenging internal fixation procedure or radial head excision. Prior to radial head replacement surgery for fractured elbow, you are advised to visit your physiotherapist to make sure you are ready for your postop rehab.
Radial head fractures cause pain and swelling around the elbow, generally. In the present report, we describe a case of such injury with irreparable radial head treated with patientspecific radial head prosthesis which was created with 3d printing technology. Reference points for radial head prosthesis size article in the journal of hand surgery 311. The radial head replacement has been accepted as the standard treatment method for irreparable radial head fractures associated with elbow instability. Radial head fracture common in adult radial neck fractures common in children radial head can be fracture during elbow dislocation articular cartilage of the capitulum may be bruised or chipped previously radial head excision was a popular treatment, now it is being replaced by open reduction and internal fixation or radial head replacement gliding during flexion. Confidence in over 25,000 sold4 modular stem and head provide over 320 size combinations to match variable anatomy smooth stem implant design supported by two long term studies 8year1 and 12 year2 average follow up simple design has no polyethylene, moving parts or set screws to wear out over time prospective data show proven performance.
Include immediate postoperative care and rehabilitation. Indications discuss indications and more general concerns. Prosthetic replacement of the radial head in case of severe arthritis or in unreconstructable fractures can lead to good short and midterm results 18. Download scientific diagram overstuffing of radial head replacement. Radial head fractures abstract open orthopaedics journal. While the average length of time of disability following these injuries is 8. Mighell, md disclosure royalties speakers bureau paid consultant research support paid consultant radial head replacement. Detrimental effects of overstuffing or understuffing with a radial head. For primary and revision joint replacement of the radial head.
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