This document discusses treatment options for radial head fractures, including conservative treatment, fixation, excision, partial excision, and replacement. It provides guidelines for treating different Mason types of fractures, noting that Mason type 1 fractures can be treated conservatively, Mason type 2 fractures should be fixed, and Mason types 3 and 4 may require fixation with ligament repair or replacement depending on associated injuries. Reasons for replacing versus fixing the radial head are discussed. While there is a lack of level 1 evidence, studies at lower levels generally show better outcomes with replacement compared to fixation for complex injuries or fractures with three or more fragments. Precise sizing and avoiding overstuffing are important with replacement.

1. Hitesh Gopalan
Clinical Asst Professor.
www.orthoevidence.com
www.orthopaedicprinciples.com

2. Radial Head
 Valgus stabiliser
 Axial Stabiliser
 60% of load transfer

3. Problems
 Comminution
 LUCL injury
 MCL injury
 Elbow Dislocation
 Coronoid fracture
 Essex Lopresti Injury(ALRUD)

5. Ligamentous Instability

6. Treatment Options
 Conserve
 Fixation
 Excision
 Partial excision
 Replacement

7. Guidelines
 Mason 1: Conservative
 Mason 2: Fix

8.  Mason 3 and 4: Fix with ligamentous repair, Replace or
Partially Excise?
 Ligamentous Instability

9. When Replace
 Mason type 3 fractures
 Associated ligamentous injuries(ALRUD)
 Complex injury(Terrible triad)

10. Replace Vs Fixation
 Three or more fragments
 Impaction
 Significant metaphyseal bone loss

11. Radial Head Excision
 Chronic ulnar wrist pain, Instability
 Elbow stiffness, Proximal radial migration 2-3 mm
 Loss of strength, Degenerative arthritis
 Cubitus valgus, Heterotopic calcification
 Myositis ossificans, Radial tunnel syndrome
 Synostosis, Ulnar neuropathy
Clin Orthop Relat Res. 1998; 353:40-52.

12. Radial Head Replacement
 monoblock metal
 press-fit and ingrowth stems,
 cemented stems, bipolar , and ceramic
 Floating Radial head prosthesis(Tornier, Fr)
 Acrylic, silicone rubber, cobaltchromium
Alloy, titanium
 Osteochondral autografts(Han KJ 2012)

13. What’s the Evidence
 Level 4
 Level 3
 Level 2
No level 1 randomised trial that compares radial head
replacement with fixation

14. Replacement –Level IV
 Moro et al..
 El Sallakh S (J Orthop Trauma 2012)
 Shore et al(JBJS A-2008)
 Excellent to Good Results in 80%
 Less reports on complications like loosening, wear

15. 




Level 3
Retrospective Case control design
Complex Injuries
Fixation (13)Vs Replacement(11)
Outcomes: ASES , DASH scores
 Better functional outcomes with Replacement

16. •Radial head replacement: 14 patients
•Radial head repair: 8 cases
•Level: IV
•Outcome assessment: Broberg and Morrey scale
•92. 9% satisfactory results in replacement group Vs 12.5 %
satisfactory results in fixation group

17. Replacement: 22 patients
Repair: 23 patients
Outcomes: Broberg and Morrey System
Analysis: Satisfactory outcome in 91% in replacement group Vs 65% in ORIF
Level 2 Randomised Trial

18. Xiao Chen et al..Int Orthop 2011

20. Replacement
 Accurate Sizing and length
 Avoid overstuffing the joint
 Damage to articular cartilage of capitellum

21. Level IV retrospective case series(n=32)
MyoPC Prosthesis
Outcomes: Broberg and Morrey, Mayo Elbow Performance
Satisfactory Outcomes

22. Radial head Fractures
 Undisplaced(Mason 1): Conservative with early
mobilisation
 Comminuted: Elderly- EXCISION

23. Radial Head
 Mason 2: one or two fragments, dense bone: Fix
 Mason 3-4: Replace

25. Thank You