Executive Editor: Peter Trafton

Authors: Kodi Kojima, Steve Velkes

Proximal forearm 21-B2 Arthroplasty

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Glossary

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 top

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Remove radial head fragments

Carefully remove all radial head fragments without 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.


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Smoothing the radial neck edges

Smoothen the radial neck edges with the help of a small rounger.

3 Final assessment top

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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.

v1.0 2016-10-24