Radial Head Arthroplasty

Functional Outcomes of Fixation Versus Replacement for Comminuted Radial Head Fractures in Adults: A Systematic Review

“…However, the biomechanical understanding of the radial head as a stabiliser and axial weight-bearing structure led to an appreciation of its functional importance. Excision has become less popular due to concerns about delayed sequelae and improvements in instrumentation for internal fixation and arthroplasty [19] . Also, not all radial head fractures are amenable to simple excision because of concomitant injuries [16] .…”

“…However, good to excellent results can be anticipated when radial head replacement is used for the correct indications and when care is taken to understand concomitant injuries [25] . Recent clinical outcome studies of metallic radial head arthroplasty systems indicate it is a reasonable option to offer patients with comminuted radial head fractures [19] . Specific complications include synostosis formation, heterotopic ossification, loosening and stiffness [26] .…”

“…These include implant fractures and silicone synovitis. These complications and biomechanical studies showing the inability of silicone implants to support the radius functionally have lead to their disuse [19] . However recently other authors have argued that the silastic implant can be used in a stable elbow with good functional and radiographic results [40] .…”

Radial Head Fractures: Indications and Technique for Primary Arthroplasty

“…Presently, a number of metallic radial head prosthesis is available, in various designs [30]. Recognizing that the complex kinematics of the elbow joint is difficult to recreate with a radial head arthroplasty, two different concepts have evolved [31]: 1.…”

“…Mostly, this involves only careful adaptation of the fracture surfaces using bone pliers. Since the exact positioning of the prosthesis is of utmost importance, the direction of the neck osteotomy must be thoroughly adjusted utilizing trial implants; this ensures centering of the implant toward the capitellum, and helps to avoid ''edge binding'' [30] and impingement against the capitellum. The height of the osteotomy must be thoroughly adjusted to bring the radiocapitellar surface of the prosthesis to lay 0-1 mm proximal to the lateral edge of the coronoid process, or preferably according to the anatomy on the uninjured side.…”