Radial Head Fractures

No Results

No Results

processing….

Radial head fractures and dislocations are traumatic injuries that require adequate treatment to prevent disability from stiffness, deformity, posttraumatic arthritis, nerve damage, or other serious complications. Radial head fractures and dislocations may be isolated just to the radial head (and neck) and the lateral elbow (and proximal forearm), or they may be part of a combined complex fracture injury pattern involving the other structures of the elbow, distal humerus, or forearm and wrist.

Radial head and neck fractures and dislocations have been treated by closed and open methods. Early attempts at closed treatment with casting resulted in stiffness and loss of function in the elbow. Consequently, treatment has evolved so that only patients with fractures stable enough to allow early motion undergo closed treatment, while essentially all other patients are treated with a form of surgical treatment.

Surgical methods have included excision of the fracture fragments, replacement, and internal fixation. Problems with proximal radial migration, especially with excision but also with replacement, and problems with the replacement implants have led to the belief that anatomic reduction and internal fixation is currently the treatment of choice for unstable and displaced radial head and neck fractures and dislocations. [1, 2, 3, 4, 5, 6]

The elbow joint consists of three bones and three joints. The bones are as follows:

The joints are as follows:

The joints are controlled by the ligamentous anatomy of the elbow. The elbow joint (ulnotrochlear joint) is constrained by the medial collateral ligament, which has well-defined anterior, posterior, and transverse bundles. The elbow is also constrained by the lateral collateral ligament, which is poorly defined, and the radial collateral, lateral ulnohumeral, and accessory collateral ligaments provide stability. The radioulnar joint is constrained by the annular ligament.

The neurovascular structures of the elbow are easily damaged in fractures and dislocations of the elbow. The physician needs to be especially aware of the ulnar nerve proximally because it passes behind the medial epicondyle and the posterior interosseous nerve, wraps around the radial neck, and is most likely to be damaged with radial head fractures or dislocations or during surgery to correct these injuries. The median nerve and the brachial artery are in danger in the front of the elbow.

Because the radial head is intra-articular, anatomic reduction of bone fragments is necessary to minimize the risks of lateral posttraumatic arthritis from mechanical grinding. The intra-articular position also means that soft-tissue attachments to the most proximal portion of the bone are limited, and thus, fractured fragments frequently lose their blood supply, resulting in avascular necrosis and potential nonunion. Luckily, the radial head mostly acts as a spacer preventing proximal migration of the radius; as long as it maintains its structural support, the patient may do well even if the bone dies.

Except for congenital radial head dislocations, which by definition are not acquired, radial head fractures and dislocations are the result of trauma, usually from a fall on the outstretched arm with the force of impact transmitted up the hand through the wrist and forearm to the radial head, which is forced into the capitellum.

Recognizing a congenital radial head dislocation (see the image below), in which the radial head is larger and rounder than expected, is important because operative treatment to reduce a congenital radial head dislocation is not indicated.

The radial head is fractured in about 20% of cases of elbow trauma. About 33% of elbow fractures and dislocations include injury to the radial head, the radial neck, or both.

For radial head and neck fractures and dislocations, the prognosis is generally good when the following are achieved [7] :

A study by Duckworth et al reported excellent long-term results with nonoperative management of isolated stable fractures of the radial head or neck. [8]

Kodde IF, Kaas L, Flipsen M, van den Bekerom MP, Eygendaal D. Current concepts in the management of radial head fractures. World J Orthop. 2015 Dec 18. 6 (11):954-60. [Medline]. [Full Text].

Struijs PA, Smit G, Steller EP. Radial head fractures: effectiveness of conservative treatment versus surgical intervention. A systematic review. Arch Orthop Trauma Surg. 2007 Feb. 127(2):125-30. [Medline].

Jackson JD, Steinmann SP. Radial head fractures. Hand Clin. 2007 May. 23(2):185-93, vi. [Medline].

Tejwani NC, Mehta H. Fractures of the radial head and neck: current concepts in management. J Am Acad Orthop Surg. 2007 Jul. 15(7):380-7. [Medline].

Rosenblatt Y, Athwal GS, Faber KJ. Current recommendations for the treatment of radial head fractures. Orthop Clin North Am. 2008 Apr. 39(2):173-85, vi. [Medline].

Pike JM, Athwal GS, Faber KJ, King GJ. Radial head fractures–an update. J Hand Surg [Am]. 2009 Mar. 34(3):557-65. [Medline].

O’Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect. 2003. 52:113-34. [Medline].

Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am. 2014 Oct 15. 96 (20):1716-23. [Medline].

Cooney WP. Radial head fractures and the role of radial head prosthetic replacement: current update. Am J Orthop. 2008 Aug. 37(8 Suppl 1):21-5. [Medline].

Schatzker J. The Rationale of Operative Fracture Care. New York: Springer Verlag; 1987.

Malmvik J, Herbertsson P, Josefsson PO, et al. Fracture of the radial head and neck of Mason types II and III during growth: a 14-25 year follow-up. J Pediatr Orthop B. 2003 Jan. 12(1):63-8. [Medline].

Foocharoen T, Foocharoen C, Laopaiboon M, Tiamklang T. Aspiration of the elbow joint for treating radial head fractures. Cochrane Database Syst Rev. 2014 Nov 22. 11:CD009949. [Medline].

Watters TS, Garrigues GE, Ring D, Ruch DS. Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis?. Clin Orthop Relat Res. 2014 Jul. 472 (7):2128-35. [Medline].

Yan M, Ni J, Song D, Ding M, Liu T, Huang J. Radial head replacement or repair for the terrible triad of the elbow: which procedure is better?. ANZ J Surg. 2015 Sep. 85 (9):644-8. [Medline].

Capo JT, Svach D, Ahsgar J, Orillaza NS, Sabatino CT. Biomechanical stability of different fixation constructs for ORIF of radial neck fractures. Orthopedics. 2008 Oct. 31 (10):[Medline].

Stuffmann E, Baratz ME. Radial head implant arthroplasty. J Hand Surg [Am]. 2009 Apr. 34(4):745-54. [Medline].

Schiffern A, Bettwieser SP, Porucznik CA, Crim JR, Tashjian RZ. Proximal radial drift following radial head resection. J Shoulder Elbow Surg. 2011 Mar. 20(3):426-33. [Medline].

Type

Description

Equivalent(s)

%

Type I

Anterior dislocation of the radial head and anterior angulation of the ulna fracture

Radial head or neck fracture instead of dislocation

60

Type II

Posterior dislocation of the radial head and posterior angulation of the ulna fracture

Posterior elbow dislocation

Radial head or neck fracture instead of dislocation

105

Type III

Lateral dislocation of the radial head with proximal ulna fracture

Radial head or neck fracture instead of dislocation

20

Type IV

Anterior dislocation of the radial head and proximal shafts of both bones fractured at same level

Radial head or neck fracture instead of dislocation

5

Steven I Rabin, MD Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Forensic Examiners Institute, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

N Ake Nystrom, MD, PhD Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Thomas M DeBerardino, MD Orthopedic Surgeon, The San Antonio Orthopaedic Group; Professor of Orthopedic Surgery, Baylor College of Medicine as Co-Director, Combined Baylor College of Medicine-The San Antonio Orthopaedic Group, Texas Sports Medicine Fellowship; Medical Director, Burkhart Research Institute for Orthopaedics (BRIO) of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Herodicus Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; MTF; Aesculap; The Foundry, Cotera; ABMT; Conmed; <br/>Received research grant from: Histogenics; Cotera; Arthrex.

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

Radial Head Fractures

Research & References of Radial Head Fractures|A&C Accounting And Tax Services
Source