Robert Longstaffe1, Graham J W King2, Jonathan P Marsh1. 1. Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada. 2. Roth McFarlane Hand & Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
Abstract
INTRODUCTION: Radial head arthroplasty with a smooth-stemmed metallic modular implant is a reliable treatment option for patients with acute unreconstructible radial head fractures, and good clinical outcomes may be expected beyond 5 years of follow-up (Video 1). STEP 1 PREOPERATIVE PLANNING: Obtain a careful history and perform a physical examination along with appropriate imaging to facilitate appropriate treatment decisions. STEP 2 OPERATING ROOM SETUP AND PATIENT POSITIONING: Perform proper operating room setup and patient positioning, as they are required to gain access to all affected structures around the elbow in a safe and efficient manner. STEP 3 APPROACH: Make a midline posterior skin incision with development of a full-thickness lateral fasciocutaneous flap or use a direct lateral incision; the deep interval is determined on the basis of the integrity of the LCL. STEP 4 RADIAL HEAD EXCISION: Remove and preserve all fragments of the radial head for implant sizing. STEP 5 IMPLANT SIZING: Implant a prosthesis that closely replicates the dimensions of the native radial head, which is the primary goal of the procedure. STEP 6 STEM BROACHING: Sequentially broach the canal until good cortical contact is achieved and undersize the definitive stem by 1 mm to allow implant movement within the canal and appropriate articulation with the capitellum. STEP 7 INSERTION OF TRIAL COMPONENTS AND FINAL RADIAL HEAD IMPLANT: With the selected trial in place, assess the radial head diameter, height, and articular congruency. STEP 8 CLOSURE AND REPAIR OF THE LCL: Ensure proper repair of the LCL as it is essential to maintaining or restoring elbow stability. STEP 9 POSTOPERATIVE PROTOCOL: Postoperative rehabilitation depends on the status of the collateral ligaments. RESULTS: In a review of the cases of 55 patients at a mean follow-up of 8 years after radial head arthroplasty with a smooth-stemmed modular metallic prosthesis, Marsh et al.9.
INTRODUCTION: Radial head arthroplasty with a smooth-stemmed metallic modular implant is a reliable treatment option for patients with acute unreconstructible radial head fractures, and good clinical outcomes may be expected beyond 5 years of follow-up (Video 1). STEP 1 PREOPERATIVE PLANNING: Obtain a careful history and perform a physical examination along with appropriate imaging to facilitate appropriate treatment decisions. STEP 2 OPERATING ROOM SETUP AND PATIENT POSITIONING: Perform proper operating room setup and patient positioning, as they are required to gain access to all affected structures around the elbow in a safe and efficient manner. STEP 3 APPROACH: Make a midline posterior skin incision with development of a full-thickness lateral fasciocutaneous flap or use a direct lateral incision; the deep interval is determined on the basis of the integrity of the LCL. STEP 4 RADIAL HEAD EXCISION: Remove and preserve all fragments of the radial head for implant sizing. STEP 5 IMPLANT SIZING: Implant a prosthesis that closely replicates the dimensions of the native radial head, which is the primary goal of the procedure. STEP 6 STEM BROACHING: Sequentially broach the canal until good cortical contact is achieved and undersize the definitive stem by 1 mm to allow implant movement within the canal and appropriate articulation with the capitellum. STEP 7 INSERTION OF TRIAL COMPONENTS AND FINAL RADIAL HEAD IMPLANT: With the selected trial in place, assess the radial head diameter, height, and articular congruency. STEP 8 CLOSURE AND REPAIR OF THE LCL: Ensure proper repair of the LCL as it is essential to maintaining or restoring elbow stability. STEP 9 POSTOPERATIVE PROTOCOL: Postoperative rehabilitation depends on the status of the collateral ligaments. RESULTS: In a review of the cases of 55 patients at a mean follow-up of 8 years after radial head arthroplasty with a smooth-stemmed modular metallic prosthesis, Marsh et al.9.
Authors: Jonathan P Marsh; Ruby Grewal; Kenneth J Faber; Darren S Drosdowech; George S Athwal; Graham J W King Journal: J Bone Joint Surg Am Date: 2016-04-06 Impact factor: 5.284
Authors: Ruby Grewal; Joy C MacDermid; Kenneth J Faber; Darren S Drosdowech; Graham J W King Journal: J Bone Joint Surg Am Date: 2006-10 Impact factor: 5.284
Authors: Michael D McKee; David M W Pugh; Lisa M Wild; Emil H Schemitsch; Graham J W King Journal: J Bone Joint Surg Am Date: 2005-03 Impact factor: 5.284