Abstract
Purpose: To review the clinical outcome of patients who have had complex radial head fractures managed with titanium radial head replacement.
Methods: There were 17 patients who had insertion of the radial head replacement. The indications for the prosthesis included acute Mason type III fracture which could not be stabilised satisfactorily with internal fixation. Other indications included delayed presentation including previously failed treatment.
Patients were managed with radial head excision and insertion of the Wright Medical titanium radial head replacement. The lateral ligamentous complex was stabilised. A back slab was applied for a period of one week and then the elbow mobilised.
The patients were followed up for a minimum of one year. The Mayo elbow performance index was used.
Results: There were 7 patients with acute injuries of which 6 had associated injuries such as dislocation or coronoid process fracture. 6 of these patients had an excellent result and 1 had a good result.
There were 9 patients with a delayed insertion of the radial head replacement. There were 3 patients who had an isolated radial head fracture and 6 patients with associated injuries, there were 2 excellent, 3 fair and 4 poor.
Three of the 4 poor results had associated capitellar chondral injury. Two patients with fair results had other significant pathology in the upper limb.
In the delayed presentation group the average flexion arc improved from 78 degrees to 102 degrees and the pro-supination improved from 117 degrees to 142 degrees. The average level of satisfaction on a visual analog score was 92 per cent.
Conclusion: Patients who present with acute complex radial head fractures (including associated injuries), the results of radial head replacement are generally excellent. If there are significant associated injuries and a delay in presentation, then the outcome is often only fair. However, this group of patients have improvement in their pain, level of satisfaction and range of motion. Associated capitellar damage is a poor prognostic indicator.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
