1. Hitesh Gopalan
Clinical Asst Professor.
www.orthoevidence.com
www.orthopaedicprinciples.com

2. Radial Head
 Valgus stabiliser
 Axial Stabiliser
 60% of load transfer

3. Problems
 Comminution
 LUCL injury
 MCL injury
 Elbow Dislocation
 Coronoid fracture
 Essex Lopresti Injury(ALRUD)

5. Ligamentous Instability

6. Treatment Options
 Conserve
 Fixation
 Excision
 Partial excision
 Replacement

7. Guidelines
 Mason 1: Conservative
 Mason 2: Fix

8.  Mason 3 and 4: Fix with ligamentous repair, Replace or
Partially Excise?
 Ligamentous Instability

9. When Replace
 Mason type 3 fractures
 Associated ligamentous injuries(ALRUD)
 Complex injury(Terrible triad)

10. Replace Vs Fixation
 Three or more fragments
 Impaction
 Significant metaphyseal bone loss

11. Radial Head Excision
 Chronic ulnar wrist pain, Instability
 Elbow stiffness, Proximal radial migration 2-3 mm
 Loss of strength, Degenerative arthritis
 Cubitus valgus, Heterotopic calcification
 Myositis ossificans, Radial tunnel syndrome
 Synostosis, Ulnar neuropathy
Clin Orthop Relat Res. 1998; 353:40-52.

12. Radial Head Replacement
 monoblock metal
 press-fit and ingrowth stems,
 cemented stems, bipolar , and ceramic
 Floating Radial head prosthesis(Tornier, Fr)
 Acrylic, silicone rubber, cobaltchromium
Alloy, titanium
 Osteochondral autografts(Han KJ 2012)

13. What’s the Evidence
 Level 4
 Level 3
 Level 2
No level 1 randomised trial that compares radial head
replacement with fixation

14. Replacement –Level IV
 Moro 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

15. 
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Level 3
Retrospective Case control design
Complex Injuries
Fixation (13)Vs Replacement(11)
Outcomes: ASES , DASH scores
 Better functional outcomes with Replacement

16. •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

17. Replacement: 22 patients
Repair: 23 patients
Outcomes: Broberg and Morrey System
Analysis: Satisfactory outcome in 91% in replacement group Vs 65% in ORIF
Level 2 Randomised Trial

18. Xiao Chen et al..Int Orthop 2011

20. Replacement
 Accurate Sizing and length
 Avoid overstuffing the joint
 Damage to articular cartilage of capitellum

21. Level IV retrospective case series(n=32)
MyoPC Prosthesis
Outcomes: Broberg and Morrey, Mayo Elbow Performance
Satisfactory Outcomes

22. Radial head Fractures
 Undisplaced(Mason 1): Conservative with early
mobilisation
 Comminuted: Elderly- EXCISION

23. Radial Head
 Mason 2: one or two fragments, dense bone: Fix
 Mason 3-4: Replace

25. Thank You