ACUTE PROSTHETIC RADIAL HEAD REPLACEMENT FOR TRAUMA – AN UNPREDICTABLE OPERATION

Abstract

Introduction and Aims: To evaluate the results of radial head replacement in the primary management of radial head fractures.

The recommended indications for prosthetic radial head replacement include unreconstructable Mason 3 fractures associated with ligament disruption or axial forearm instability.

Method: We retrospectively reviewed all radial head fractures that were treated with a radial head replacement, over a four-year period, in two district general hospitals. All seven patients were finally assessed specifically for this study, either in person or by telephone/ postal questionnaire, with final radiographs obtained for this study.

Results: Routine clinical follow-up was three months, following which the patient was discharged. No patient achieved full functional range of motion. The average range of flexion was 110 degrees (range 80 to 120 degrees), average extension deficit of 35 degrees (range 30 to 45 degrees), average pronation was 35 degrees (range 0 to 65 degrees), and average supination was 50 degrees (range 30 to 85 degrees). Three patients required implant removal due to loosening (1/3), elbow stiffness (2/3), and instability (1/3), the latter case requiring a revision of the radial head prosthesis. Persistent discomfort was noticed in all cases. Four patients were tolerant of the final functional outcome, although the average Mayo elbow score was 78/100 (range 55 to 80).

Conclusion: Radial head replacement in general orthopaedic, low volume, practice failed to achieve satisfactory results. Contrary to popular belief, it is a technically demanding operation, for which surveillance should be continued for a minimum of one year. Strict indications for prosthetic replacement should be followed and implant selection has yet to be proven to make a significant positive contribution