A displaced and badly comminuted fracture of the radial head is part of a complex instability injury of 3 joints namely elbow, radio-ulnar and wrist joints. If it is associated with Mason type IV and Essex Lopresti injury to forearm, simple
excision of the radial head may lead to instability of the elbow joint and painfully restricted movements of the wrist.
Management should be aimed at achieving the normal anatomy so that the function of elbow, radio-ulnar and wrist
joints will be restored to a satisfactory level. We report the medium term result of a patient who had prosthetic replacement of radial head. Our patient in this case report was informed, that the details of the management would be
submitted for publication.
3. The role of prosthetic replacement in the management of comminuted radial head fractures
Case Report
337
DRUJ or wrist joint. At his next visit at 18 months
following surgery he has full pronation with marginal
improvement in flexion and extension. X-ray of the elbow
did not show any evidence of prosthesis loosening or
erosion of the capitellum.
DISCUSSION
Fig. 1 Pre-operative X-ray showing fracture dislocation of
elbow joint.
possible by inserting less or more of the prosthetic stem in
to the medullary canal to appropriately support the capitellum. There was no valgus instability after reducing the
radial head suggesting the integrity of medial collateral
ligament. At 90 of flexion elbow joint was stable and
hence no attempt was made to fix the small fragment of
coronoid process. Elbow was immobilised at about 100
of flexion and forearm in full supination to maintain
maximum interosseous space.
Active and active assisted movements were started after
3 weeks. Four months following the procedure, patient
regained 15 short of full extension with terminal restriction
of flexion. There was terminal restriction of both supination
and pronation. Elbow joint was stable and he has no pain at
Resection of the radial head for simple fractures has been
shown to give satisfactory long term results.1,2 However
unrecognised complex injuries with elbow or axial forearm
instability may be responsible for unstable elbow, proximal
migration of radius, with or without chronic wrist pain.3
This instability is a major concern in young and active
people whereas in a relatively sedentary and elderly people
it may not cause any significant problem for the day to day
activities. Silicon radial head prosthesis did not offer rigid
stability. Proximal migration of the radius progressed with
break-up of the implant and subsequent synovitis.4,5
Metallic radial head offered better stability against valgus
forces at elbow and axial forearm instability.6e8 However
over stuffing of the radio capitellar joint must be avoided,
as it may produce capitellar erosion especially when done
as a late reconstructive procedure for chronic wrist pain.9
We recommend this procedure strongly in young people
to avoid long term consequences of elbow, radio-ulnar
and wrist joint instabilities. Loosening of the stem as
a major complication was not reported in the literature
when the procedure was done in young people. We believe
that for any reason if the prosthesis has to be explanted after
a period of 6e12 months it may not lead to any instabilities
mentioned above as the interosseous membrane and other
soft tissues would have got stabilised by then to a large
extent preventing proximal migration of radial shaft. Even
though the role of radial head prosthesis in stabilising the
elbow and axial forearm instability seems well proven, it
is being used less often mainly because of lack of awareness of secondary instability and non-availability of radial
head prosthesis.
CONFLICTS OF INTEREST
All authors have none to declare.
REFERENCES
Fig. 2 Post-operative X-ray showing radial head replacement.
1. Goldberg I, Peylan J, Yosipovitch Z. Late results of excision of
the radial head for an isolated closed fracture. J Bone Joint Surg
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2. Morrey BF, Chao EY, Hui FC. Biomechanical study of the
elbow following excision of the radial head. J Bone Joint
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3. Sowa DT, Hotchkiss RN, Welland AJ. Symptomatic proximal
translation of the radius following radial head resection. Clin
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4. Morrey BF, Askew L, Chao EY. Silastic prosthesis replacement
for the radial head. J Bone Joint Surg Am. 1981;63:454e458.
5. Valderwilde RS, Morrey BF, Melberg MW, Vinh TN. Inflammatory arthritis after failure of silicon rubber replacement of the
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6. Moro JK, Werler J, MacDermid JC, Patterson SD, King GJ.
Arthroplasty with a metal radial head for unreconstructable
Mohan Krishna and Somasekhar Reddy
fractures of the radial head. J Bone Joint Surg Am. 2001;83:
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7. Bain GI, Ashwood N, Baird R, Unni R. Management of Mason
type III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. J Bone Joint Surg Am.
2005;87:65e76.
8. Grewal Ruby, Dermid Joy C, Faber Kenneth J,
Drosdowech Darren S, King Graham JW. Comminuted radial
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9. Van Riet Roger P, Van Glabbeek Francis, Verborgt Olivier,
Gielen Jan. Capitellar erosion caused by metal radial head prosthesis. J Bone Joint Surg Am. 2004;86:1061e1064.
Erratum to “Colour Doppler ultrasound in controlled ovarian
stimulation with intrauterine insemination”
[Apollo Med 9 (3) (2012) 252e263]
Kavita Bhadauriaa,*, Reeti Sahnib, Sohani Vermab, Payal Q. Khatric
The above mentioned article published in the September issue is an Original Article, but was published as a Case Report by
mistake. The journal regrets for this error.
DOI of original article: 10.1016/j.apme.2012.07.014.
a
Resident, bSenior Consultant, cAssociate Consultant, Department
of Radiodiagnosis and AARU, Indraprashta Apollo Hospitals, New
Delhi 110076, India.
*
Corresponding author.
Copyright Ó 2012, Indraprastha Medical Corporation Ltd. All rights
reserved.
http://dx.doi.org/10.1016/j.apme.2012.11.001
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