1 Indication top
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.
2 Resection of the radial head topenlarge
Remove radial head fragments
Carefully remove all radial head fragments without damage to the annular ligament.
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 rounger.
3 Final assessment topenlarge
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.
X-rays of the elbow are advisable to look for remaining fragments and alignment. X-rays of the wrist, compared with the opposite (intact) side, may demonstrate radial shortening. If this is present, it should be corrected with a proximal radius prosthesis.