Radial Head Replacement BEST EVIDENCE Hitesh Gopalan Clinical Asst Professor. www.orthoevidence.com www.orthopaedicprinciples.com
Nov 02, 2014
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