In unreconstructable radial head fractures, the excision is indicated:
- in isolated radial head fracture
- in low energy fracture
- in radial head fracture without associated fracture or ligament injury
Radial head excision can produce instability of elbow or forearm (Essex-Lopresti lesion). Thus, it is contraindicated when the elbow joint is unstable (eg, coronoid fracture and / or collateral ligament rupture), or when the interosseous membrane and DRUJ have been injured.
Remove radial head fragments
Carefully remove all radial head fragments without further damage to the annular ligament.
Pearl: Reconstruct the radial head on a side-table to make sure that all fragments have been removed from the joint.
Smoothing the radial neck edges
Smoothen the radial neck edges with the help of a small rongeur.
Do not unnecessarily further resect the neck.
If the annular ligament is ruptured, repair it with non-absorbable sutures. Check elbow range of motion in flexion, extension, pronation and supination. Check elbow stability.
Intraoperative C-arm evaluation is advisable to look for remaining fragments and alignment (as shown in the X-ray).
Also check the wrist with a C-arm and compare to the contralateral side to rule out radial shortening. If this is present it should be corrected with a radial head prosthesis.