Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm Radius, extraarticular, multifragmentary

back to skeleton

Glossary

Fragmented metaphyseal diaphyseal fracture of the radial neck are uncommon and usually associated with an elbow fracture-dislocation.

Nonoperative
Indication summary Skill Equipment
Well aligned elbow and likely to remain so 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.

Contraindications

  • Elbow subluxation or dislocation
  • Deformity likely to restrict forearm rotation
  • Infirm or dependent person
  • Polytrauma

Advantages

  • Avoids surgical risks of neurovascular injury
  • Fragmented radial neck fractures extending to the bicipital tuberosity are difficult to stabilize adequately

Disadvantages

  • Risk of elbow subluxation, elbow stiffness, and hindrance of forearm rotation
Radial head arthroplasty
Indication summary Skill Equipment
Irreparable radial head and neck Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Further indications

  • In setting of fracture dislocations with instability or residual subluxation

Advantages

  • Allows for early motion

Disadvantages

  • Early loosening of the prosthesis
  • Risk of elbow stiffness (prosthesis too large)
  • Risk of unstable elbow (prosthesis too small)
Bridge plate
Indication summary Skill Equipment
Displaced or unstable fracture when stable fixation is possible Highly experienced and skilled surgeon Simple surgical and imaging resources

Further indications

  • Fragmented fracture associated with elbow dislocation
  • Restriction of forearm rotation

Contraindications

  • No associated ligament injury (consider nonoperative treatment or resection of radial head)

Advantages

  • Stabilizes elbow and forearm
  • Retains native radial head

Disadvantages

  • Risk of radial nerve injury and implant prominence and restriction of forearm rotation
  • Technically demanding
*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