3. 1.5 to 4 % of all fractures in adult
33 % of all elbow injuries
4. Isolated Radial head
fractures
• Davidson et al- all 111 patients
with entire radial head fractures
had associated wrist or elbow
ligamentous injury( clin orthop
1993)
• 30 – 70% associated injuries in
various studies
7. Isolated Radial head
fractures
• “Entire radial head fracture or
displaced partial radial head
fracture always associated with
ligamentous injury-” Rockwood and
Green
10. APPLIED ANATOMY
• Radial head act as secondary
stabilizer to valgus stress, primary
being MCL
• Radial head resection in presence
of intact MCL does not alter valgus
instability much
21. CLINICAL
EVALUATION
• Even minor fractures are painful due
to haemarthrosis
• Document forearm rotation after LA
injection to joint to rule out
mechanical block
29. HOTCHKISS
MODIFICATION OF MASON
CLASSIFICATION
• TYPE 2- displaced partial radial head
fracture that blocks forearm rotation/
entire radial head fracture amenable to
fixation, treatment is ORIF
31. Goals of treatment
• Correcton of block to free forearm
rotation
• Stable elbow
• Prevent late arthrosis
• Early mobilisation
32. Non operative treatment
• Modified mason 1 fractures
• No associated lig injuries
• No bony block to ROM
33. Non operative treatment
• Early(3-4d) ROM
• Large undisplaced fragments need to be
monitored with x-ray
• Loss of elbow extension
• Redisplacement
• Non union
• Various studies have reported 90% favourable
results in mason 1 injury
34. Non operative treatment
• 80% favourable result with MASON
2&3 fractures treated
nonoperatively and added with
delayed radial head excision when
required for pain(JBJS (Am) :86-
A; 3, 570.)
42. CONSIDER ORIF
• Displaced MASON 2(>2mm) partial
radial head fractures which block
forearm rotations
• Entire radial head fractures with
unstable elbow if
– Less than three articular fragments
– Sufficient size and bone quality ti accept screws
– No metaphyseal bone loss
45. • Better understanding of anatomy and safezones
for implant and current implants have improved
clinical results of internal fixation
• King et al have repoted 100% excellent results
with internal fixation for Mason 2 fractures
• They have reported only 33%good results with
Mason 3 fractures treated by internal fixation
46. • Due to inadequate fixation or
selection of fracture pattern-
include
• Nonunion
• Restriction of forearm motion
• Implant failure
• Infection
• PIN injury
50. Primary Radial head
excision
Modified mason 3 fractures with
» Intact MCL
» No injury to DRUJ
» Coronoid and olecranon
intact
• Partial radial head fractures hindering
forearm rotation not amenable to
reconstruction
51. 15 yr follow up studies
• Antuna et al- 81 % painfree ,
radigraphic OA did not produce
clinical symptoms
• Hebertson et al- 90% excellent
results, OA changes in 50%
52. COMPLICATIONS
• LOSS OF ELBOW MOTION
• LOSS OF STRENGTH
• ELBOW OA CHANGES
• PROXIMAL MIGRATION OF
RADIUS( up to 2 mm assymptomatic)
• WRIST PAIN
• VALGUS INSTABILITY OF ELBOW
54. Radal head arthroplasty
• Silicone prosthesis
• Insabilty
• Destructive synovitis
• Discarded
• Metal prosthesis
– Press fit / cemented
– Smooth stem
– Unipolar or modular bipolar head
55. • Smooth stem
• Act like spacer
• Produce
radiolucencies but
asymptomatic
• No overstuffing of
radiocapitellar joint
56. • Fixed stem
• Overstuffing if radiocapitellar joint if
prosthesis more than 1 mm proximal to
coronoid process
• Open up elbow on lateral side
• Capitellar wear and synovitis
• So exact sizing must
• No significant diff b/w monopolar or bipolar
heads
58. TAKE HOME MESSAGE
• Isolated radial head fracture do occur
but is rare
• Always look for wrist or elbow
ligamentous injury
• Document forearm rotation
• Nonoperative treatment involves
supervised mobilization NOT
immobilization
59. TAKE HOME MESSAGE
• Selection of type of fracture
amenable to fixation crucial
• Follow safe zones for implants
• Radial head arthroplasty is still
evolving
