Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm Radius, complete articular

back to skeleton

Glossary

Treatment depends on 1) Associated injuries that may create elbow or forearm instability, and 2) Restriction of forearm rotation.

Nonoperative
Indication summary Skill Equipment
Undisplaced or minimally displaced fractures with acceptable supination and pronation range. Immobilization desired. Basic surgical experience, no specialized skills Basic equipment only

Note: Nonoperative treatment is generally only indicated if functional forearm rotation can be demonstrated with or without anesthetic injection.

Further indications

  • Infirm or dependent person

Contraindications

  • Presence of elbow or forearm subluxation
  • Polytrauma

Advantages

  • Allows immediate motion and stretching exercises to avoid elbow stiffness

Disadvantages

  • Malunion of the radial head restricting forearm rotation and elbow subluxation can be difficult to salvage later.
Plate and screws
Indication summary Skill Equipment
Reconstructable multifragmentary fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Further indications

  • After elevation of an impacted fracture

Advantages

  • Fracture compression
  • Rotational control of the radial head

Disadvantages

  • Risk of malpositioning of the plate outside the “safe zone”, beyond which the plate may block rotation of the radius, by impinging on the proximal radioulnar joint
  • Risk to the posterior interosseous nerve
Radial head excision
Indication summary Skill Equipment
Isolated unreconstructable radial head fracture with stable elbow but limited forearm rotation. Intact interosseous membrane and distal radioulnar joint (DRUJ). Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Simple fracture
  • Associated coronoid fracture (>50%)
  • DRUJ injury

Advantages

  • Fast procedure
  • Good functional recovery
  • Inexpensive and easy technique

Disadvantages

  • Risk of missed Essex-Lopresti injury
  • Risk of unstable elbow after wrong diagnosis
  • Risk of late proximal migration of the radius
Radial head arthroplasty
Indication summary Skill Equipment
Inability to reconstruct radial head fracture so that it provides sufficient stability for elbow joint Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Unreconstructable radial head fracture associated with an unstable fracture of the coronoid process
  • After radial head excision with evidence of medial collateral ligament insufficiency or ulnohumeral instability
  • Unreconstructable radial head fracture associated with interosseous membrane injury and distal radioulnar joint subluxation (Essex-Lopresti injury)

Contraindications

  • Simple fracture
  • Reconstructable multifragmentary fracture
  • Stable elbow

Advantages

  • Fast procedure
  • Good functional recovery
  • Stable elbow

Disadvantages

  • Early loosening of the prosthesis
  • Risk of elbow stiffness (prosthesis too large)
  • Risk of unstable elbow (prosthesis too small)
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2018-04-30