Christian Ries1, Marcel Müller2, Kilian Wegmann3, Doreen B Pfau4, Lars P Müller3, Klaus J Burkhart5. 1. Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany. Electronic address: christian.ries@uk-koeln.de. 2. Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany. 3. Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany. 4. Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. 5. Department for Shoulder Surgery, Rhön-Klinikum, Bad Neustadt, Germany.
Abstract
BACKGROUND: Proximal radial fractures are common elbow injuries. Because of the fracture pattern, stability criteria, or plate configuration, a plate position outside the "safe zone" (SZ) may be required in some cases when performing a radial head plate osteosynthesis. We examined the gross anatomy of the radial head and analyzed different so-called low-profile and precontoured radial head and neck plates with respect to the SZ. MATERIALS AND METHODS: Macroscopic measurements of the radial head and neck of 22 formalin-fixed human cadaveric upper extremities were obtained. The SZ was determined by maximum forearm rotation. If the edge of a plate could be extended beyond the respective SZ boundary without jeopardizing the proximal radioulnar joint (PRUJ) in maximum forearm rotation, a new plate-specific SZ boundary was set. RESULTS: The mean SZ was 133° (SD, 14°). Among the 5 plates studied, only the 2 radial neck designs allowed the anterior edge of the plate to partially pass the lesser sigmoid notch of the ulna and consequently afforded a significant extension of the SZ in maximum pronation. All 3 radial head designs had to remain within the SZ to avoid interference with the PRUJ. A safe plate position depends on individual plate dimensions, particularly the proximal plate width, and the diameter of the radial head. The smaller the head diameter, the more accurately a plate must be placed within the SZ. CONCLUSIONS: If an extension of the SZ in radial head plate osteosynthesis is not essential, we recommend respecting the SZ to minimize the possibility of interference with the PRUJ.
BACKGROUND: Proximal radial fractures are common elbow injuries. Because of the fracture pattern, stability criteria, or plate configuration, a plate position outside the "safe zone" (SZ) may be required in some cases when performing a radial head plate osteosynthesis. We examined the gross anatomy of the radial head and analyzed different so-called low-profile and precontoured radial head and neck plates with respect to the SZ. MATERIALS AND METHODS: Macroscopic measurements of the radial head and neck of 22 formalin-fixed human cadaveric upper extremities were obtained. The SZ was determined by maximum forearm rotation. If the edge of a plate could be extended beyond the respective SZ boundary without jeopardizing the proximal radioulnar joint (PRUJ) in maximum forearm rotation, a new plate-specific SZ boundary was set. RESULTS: The mean SZ was 133° (SD, 14°). Among the 5 plates studied, only the 2 radial neck designs allowed the anterior edge of the plate to partially pass the lesser sigmoid notch of the ulna and consequently afforded a significant extension of the SZ in maximum pronation. All 3 radial head designs had to remain within the SZ to avoid interference with the PRUJ. A safe plate position depends on individual plate dimensions, particularly the proximal plate width, and the diameter of the radial head. The smaller the head diameter, the more accurately a plate must be placed within the SZ. CONCLUSIONS: If an extension of the SZ in radial head plate osteosynthesis is not essential, we recommend respecting the SZ to minimize the possibility of interference with the PRUJ.
Authors: Robert Gray; Nathan Hoekzema; Francisco Rubio; John Heifner; Allicia Imada; Natasha Dark; Kelly Scott; Deana Mercer Journal: JSES Int Date: 2022-04-02
Authors: G H Sandmann; M Crönlein; M Neumaier; M Beirer; A Buchholz; U Stöckle; P Biberthaler; S Siebenlist Journal: Eur J Med Res Date: 2016-04-12 Impact factor: 2.175