Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm Radius, partial articular

back to skeleton

Glossary

1 Introduction 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

Radial head excision enlarge

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.


Radial head excision enlarge

Smoothing the radial neck edges

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

Do not unnecessarily further resect the neck.

3 Final intraoperative assessment top

Radial head excision enlarge

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.

v2.0 2018-04-30