SlideShare a Scribd company logo
The Role of Prosthetic Replacement in the Management of
Comminuted Radial Head Fractures
Apollo Medicine 2012 December
Volume 9, Number 4; pp. 336e338

Case Report

The role of prosthetic replacement in the management of comminuted
radial head fractures
A. Mohan Krishnaa, N. Somasekhar Reddyb,*

ABSTRACT
A displaced and badly comminuted fracture of the radial head is part of a complex instability injury of 3 joints namely
elbow, radio-ulnar and wrist joints. If it is associated with Mason type IV and Essex Lopresti injury to forearm, simple
excision of the radial head may lead to instability of the elbow joint and painfully restricted movements of the wrist.
Management should be aimed at achieving the normal anatomy so that the function of elbow, radio-ulnar and wrist
joints will be restored to a satisfactory level. We report the medium term result of a patient who had prosthetic
replacement of radial head. Our patient in this case report was informed, that the details of the management would be
submitted for publication.
Copyright © 2012, Indraprastha Medical Corporation Ltd. All rights reserved.
Keywords: Radial head fracture, Radial head prosthesis, Fracture dislocation of elbow, Radial head replacement,
Radial head fracture with DRUJ instability

CASE REPORT
A 30-year-old gentleman was admitted following a road
traffic accident with injury to his right upper limb. He
had an elbow deformity with pain over forearm down to
the wrist. He has mild fullness over volar aspect of the forearm with tenderness over the dorsum of the distal radioulnar joint and wrist joints with limitation of movements.
X-rays confirmed dislocation of the elbow joint with
a comminuted, displaced fracture of the radial head and
fracture of the tip of the coronoid process. There was no
gross dislocation at the distal radio-ulnar joint on the
X-ray (Fig. 1).
Surgery was done under brachial block. Dislocation was
first reduced. Radial head was exposed through a postero
lateral approach. It was found to be too comminuted to
fix and was excised. There was about 3e5 mm of linear
translatory movement between the radius and ulna confirming the axial forearm instability. Then the radial head was

a

recreated using the excised fragments. It is very important
for two reasons. One is to make sure that all the broken
pieces were removed. The second reason is to size the
appropriate prosthetic component. Radial neck was
prepared to get a uniform cut and the medullary canal
was prepared with a gouge and a narrow pointed rasp.
Sometimes a high-speed burr is necessary to shape the
medullary canal to accept the stem of the trial component.
The preparation of the medullary canal can be tedious as
one cannot hammer the prosthesis in to the canal due to
the high risk of fracture of radial neck and shaft. I used
chrome cobalt uncemented prosthesis (Corin) (Fig. 2).
This implant comes in three diameters and each diameter
comes with a thick and a thin head, making a total of 6
sizes. When the natural radial head diameter falls in
between the prosthetic sizes it is advisable to go for the
smaller prosthetic head. This is to prevent over stuffing
the proximal radio-ulnar joint. But the thickness of the
head should be maintained as close to the natural as

Consultant Orthopaedic Surgeon, bSenior Consultant Orthopaedic Surgeon, Apollo Hospitals, Hyderabad, India.
Corresponding author. Room No. 957, Apollo Hospitals, Jubilee Hills, Hyderabad 500 033, India. Tel.: þ91 98480 25355, email: nreddy12@
yahoo.com
Received: 4.7.2012; Accepted: 4.8.2012; Available online 21.8.2012
Copyright Ó 2012, Indraprastha Medical Corporation Ltd. All rights reserved.

*

http://dx.doi.org/10.1016/j.apme.2012.08.002
The role of prosthetic replacement in the management of comminuted radial head fractures

Case Report

337

DRUJ or wrist joint. At his next visit at 18 months
following surgery he has full pronation with marginal
improvement in flexion and extension. X-ray of the elbow
did not show any evidence of prosthesis loosening or
erosion of the capitellum.

DISCUSSION

Fig. 1 Pre-operative X-ray showing fracture dislocation of
elbow joint.

possible by inserting less or more of the prosthetic stem in
to the medullary canal to appropriately support the capitellum. There was no valgus instability after reducing the
radial head suggesting the integrity of medial collateral
ligament. At 90 of flexion elbow joint was stable and
hence no attempt was made to fix the small fragment of
coronoid process. Elbow was immobilised at about 100
of flexion and forearm in full supination to maintain
maximum interosseous space.
Active and active assisted movements were started after
3 weeks. Four months following the procedure, patient
regained 15 short of full extension with terminal restriction
of flexion. There was terminal restriction of both supination
and pronation. Elbow joint was stable and he has no pain at

Resection of the radial head for simple fractures has been
shown to give satisfactory long term results.1,2 However
unrecognised complex injuries with elbow or axial forearm
instability may be responsible for unstable elbow, proximal
migration of radius, with or without chronic wrist pain.3
This instability is a major concern in young and active
people whereas in a relatively sedentary and elderly people
it may not cause any significant problem for the day to day
activities. Silicon radial head prosthesis did not offer rigid
stability. Proximal migration of the radius progressed with
break-up of the implant and subsequent synovitis.4,5
Metallic radial head offered better stability against valgus
forces at elbow and axial forearm instability.6e8 However
over stuffing of the radio capitellar joint must be avoided,
as it may produce capitellar erosion especially when done
as a late reconstructive procedure for chronic wrist pain.9
We recommend this procedure strongly in young people
to avoid long term consequences of elbow, radio-ulnar
and wrist joint instabilities. Loosening of the stem as
a major complication was not reported in the literature
when the procedure was done in young people. We believe
that for any reason if the prosthesis has to be explanted after
a period of 6e12 months it may not lead to any instabilities
mentioned above as the interosseous membrane and other
soft tissues would have got stabilised by then to a large
extent preventing proximal migration of radial shaft. Even
though the role of radial head prosthesis in stabilising the
elbow and axial forearm instability seems well proven, it
is being used less often mainly because of lack of awareness of secondary instability and non-availability of radial
head prosthesis.

CONFLICTS OF INTEREST
All authors have none to declare.

REFERENCES

Fig. 2 Post-operative X-ray showing radial head replacement.

1. Goldberg I, Peylan J, Yosipovitch Z. Late results of excision of
the radial head for an isolated closed fracture. J Bone Joint Surg
Am. 1986;68:675e679.
338

Apollo Medicine 2012 December; Vol. 9, No. 4

2. Morrey BF, Chao EY, Hui FC. Biomechanical study of the
elbow following excision of the radial head. J Bone Joint
Surg Am. 1979;61:63e68.
3. Sowa DT, Hotchkiss RN, Welland AJ. Symptomatic proximal
translation of the radius following radial head resection. Clin
Orthop. 1995;317:106e113.
4. Morrey BF, Askew L, Chao EY. Silastic prosthesis replacement
for the radial head. J Bone Joint Surg Am. 1981;63:454e458.
5. Valderwilde RS, Morrey BF, Melberg MW, Vinh TN. Inflammatory arthritis after failure of silicon rubber replacement of the
radial head. J Bone Joint Surg Br. 1994;76:78e81.
6. Moro JK, Werler J, MacDermid JC, Patterson SD, King GJ.
Arthroplasty with a metal radial head for unreconstructable

Mohan Krishna and Somasekhar Reddy

fractures of the radial head. J Bone Joint Surg Am. 2001;83:
1201e1211.
7. Bain GI, Ashwood N, Baird R, Unni R. Management of Mason
type III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. J Bone Joint Surg Am.
2005;87:65e76.
8. Grewal Ruby, Dermid Joy C, Faber Kenneth J,
Drosdowech Darren S, King Graham JW. Comminuted radial
head fractures treated with a modular metallic radial head
arthroplasty. J Bone Joint Surg Am. 2006;88:2192e2200.
9. Van Riet Roger P, Van Glabbeek Francis, Verborgt Olivier,
Gielen Jan. Capitellar erosion caused by metal radial head prosthesis. J Bone Joint Surg Am. 2004;86:1061e1064.

Erratum to “Colour Doppler ultrasound in controlled ovarian
stimulation with intrauterine insemination”
[Apollo Med 9 (3) (2012) 252e263]
Kavita Bhadauriaa,*, Reeti Sahnib, Sohani Vermab, Payal Q. Khatric
The above mentioned article published in the September issue is an Original Article, but was published as a Case Report by
mistake. The journal regrets for this error.

DOI of original article: 10.1016/j.apme.2012.07.014.
a
Resident, bSenior Consultant, cAssociate Consultant, Department
of Radiodiagnosis and AARU, Indraprashta Apollo Hospitals, New
Delhi 110076, India.
*
Corresponding author.
Copyright Ó 2012, Indraprastha Medical Corporation Ltd. All rights
reserved.
http://dx.doi.org/10.1016/j.apme.2012.11.001
A o oh s i l ht:w wa o o o p a . m/
p l o p a : t / w .p l h s i lc
l
ts p /
l
ts o
T ie: t s / ie. m/o p a A o o
wt rht :t t r o H s i l p l
t
p /w t c
ts
l
Y uu e ht:w wy uu ec m/p l h s i ln i
o tb : t / w . tb . a o o o p a i a
p/
o
o
l
ts d
F c b o : t :w wfc b o . m/h A o o o p a
a e o k ht / w . e o k o T e p l H s i l
p/
a
c
l
ts
Si s ae ht:w wsd s aen t p l _ o p a
l e h r: t / w .i h r.e/ o o H s i l
d
p/
le
A l
ts
L k d : t :w wl k d . m/ mp n /p l -o p a
i e i ht / w . e i c c a y o oh s i l
n n p/
i
n no o
a l
ts
Bo : t :w wl s l e l . /
l ht / w . t a h a hi
g p/
e tk t n

More Related Content

What's hot

Alveolar bone / dental implant courses
Alveolar bone / dental implant coursesAlveolar bone / dental implant courses
Alveolar bone / dental implant courses
Indian dental academy
 
Immediate loading of implants in partially and fully edentulous jaw
Immediate loading of implants in partially and fully edentulous jawImmediate loading of implants in partially and fully edentulous jaw
Immediate loading of implants in partially and fully edentulous jaw
Azkah Qazi
 
Implants in Orthodontics
Implants in OrthodonticsImplants in Orthodontics
Implants in Orthodontics
Saibel Farishta
 
Immediate Implants
Immediate ImplantsImmediate Implants
Immediate Implants
Jehan Dordi
 
Bone grafting(PT)
Bone grafting(PT)Bone grafting(PT)
Bone grafting(PT)
MarufulHasan3
 
Medical device knee implant
Medical device knee implantMedical device knee implant
Medical device knee implant
Valeria Antonella Aguirre
 
Bone grafting
Bone graftingBone grafting
Bone grafting
Barun Patel
 
bone graft /certified fixed orthodontic courses by Indian dental academy
 bone graft /certified fixed orthodontic courses by Indian dental academy  bone graft /certified fixed orthodontic courses by Indian dental academy
bone graft /certified fixed orthodontic courses by Indian dental academy
Indian dental academy
 
Future of joint replacements by Dr.A.K.Venkatachalam
Future of joint replacements  by Dr.A.K.VenkatachalamFuture of joint replacements  by Dr.A.K.Venkatachalam
Future of joint replacements by Dr.A.K.Venkatachalam
Alampallam Venkatachalam
 
Teaching and Learning Complex and Uncommon Surgery
Teaching and Learning Complex and Uncommon SurgeryTeaching and Learning Complex and Uncommon Surgery
Teaching and Learning Complex and Uncommon Surgery
Alphonsus Chong
 
Implants And Prosthetics
Implants And ProstheticsImplants And Prosthetics
Implants And Prosthetics
shabeel pn
 
Christensen prosthesis
Christensen prosthesisChristensen prosthesis
Christensen prosthesis
NikitaChhabariya
 
Central incisor implant
Central incisor implantCentral incisor implant
Central incisor implant
Nader Elbokle
 
PBL
PBLPBL
Biology and biomechanics of extraoral appliances /certified fixed orthodontic...
Biology and biomechanics of extraoral appliances /certified fixed orthodontic...Biology and biomechanics of extraoral appliances /certified fixed orthodontic...
Biology and biomechanics of extraoral appliances /certified fixed orthodontic...
Indian dental academy
 
ACL Reconstruction - Update 2012
ACL Reconstruction - Update 2012ACL Reconstruction - Update 2012
ACL Reconstruction - Update 2012
Alan M. Hirahara, M.D., FRCSC
 
Orthopedic appliances
Orthopedic appliancesOrthopedic appliances
Orthopedic appliances
Karuna Sawhney
 
Bone grafts and bone grafts substitutes
Bone grafts and bone grafts substitutesBone grafts and bone grafts substitutes
Bone grafts and bone grafts substitutes
siddharth438
 
Bone grafts for dental implants
Bone grafts for dental implantsBone grafts for dental implants
Bone grafts for dental implants
keralahealthcareholiday
 
141 806-1-pb
141 806-1-pb141 806-1-pb
141 806-1-pb
Abu-Hussein Muhamad
 

What's hot (20)

Alveolar bone / dental implant courses
Alveolar bone / dental implant coursesAlveolar bone / dental implant courses
Alveolar bone / dental implant courses
 
Immediate loading of implants in partially and fully edentulous jaw
Immediate loading of implants in partially and fully edentulous jawImmediate loading of implants in partially and fully edentulous jaw
Immediate loading of implants in partially and fully edentulous jaw
 
Implants in Orthodontics
Implants in OrthodonticsImplants in Orthodontics
Implants in Orthodontics
 
Immediate Implants
Immediate ImplantsImmediate Implants
Immediate Implants
 
Bone grafting(PT)
Bone grafting(PT)Bone grafting(PT)
Bone grafting(PT)
 
Medical device knee implant
Medical device knee implantMedical device knee implant
Medical device knee implant
 
Bone grafting
Bone graftingBone grafting
Bone grafting
 
bone graft /certified fixed orthodontic courses by Indian dental academy
 bone graft /certified fixed orthodontic courses by Indian dental academy  bone graft /certified fixed orthodontic courses by Indian dental academy
bone graft /certified fixed orthodontic courses by Indian dental academy
 
Future of joint replacements by Dr.A.K.Venkatachalam
Future of joint replacements  by Dr.A.K.VenkatachalamFuture of joint replacements  by Dr.A.K.Venkatachalam
Future of joint replacements by Dr.A.K.Venkatachalam
 
Teaching and Learning Complex and Uncommon Surgery
Teaching and Learning Complex and Uncommon SurgeryTeaching and Learning Complex and Uncommon Surgery
Teaching and Learning Complex and Uncommon Surgery
 
Implants And Prosthetics
Implants And ProstheticsImplants And Prosthetics
Implants And Prosthetics
 
Christensen prosthesis
Christensen prosthesisChristensen prosthesis
Christensen prosthesis
 
Central incisor implant
Central incisor implantCentral incisor implant
Central incisor implant
 
PBL
PBLPBL
PBL
 
Biology and biomechanics of extraoral appliances /certified fixed orthodontic...
Biology and biomechanics of extraoral appliances /certified fixed orthodontic...Biology and biomechanics of extraoral appliances /certified fixed orthodontic...
Biology and biomechanics of extraoral appliances /certified fixed orthodontic...
 
ACL Reconstruction - Update 2012
ACL Reconstruction - Update 2012ACL Reconstruction - Update 2012
ACL Reconstruction - Update 2012
 
Orthopedic appliances
Orthopedic appliancesOrthopedic appliances
Orthopedic appliances
 
Bone grafts and bone grafts substitutes
Bone grafts and bone grafts substitutesBone grafts and bone grafts substitutes
Bone grafts and bone grafts substitutes
 
Bone grafts for dental implants
Bone grafts for dental implantsBone grafts for dental implants
Bone grafts for dental implants
 
141 806-1-pb
141 806-1-pb141 806-1-pb
141 806-1-pb
 

Similar to The Role of Prosthetic Replacement in the Management of Comminuted Radial Head Fractures

An isolated posterior dislocation of radial head in adults - A rare injury: A...
An isolated posterior dislocation of radial head in adults - A rare injury: A...An isolated posterior dislocation of radial head in adults - A rare injury: A...
An isolated posterior dislocation of radial head in adults - A rare injury: A...
Apollo Hospitals
 
An isolated posterior dislocation of radial head in adults – A rare injury: A...
An isolated posterior dislocation of radial head in adults – A rare injury: A...An isolated posterior dislocation of radial head in adults – A rare injury: A...
An isolated posterior dislocation of radial head in adults – A rare injury: A...
Apollo Hospitals
 
Bone conserving hip arthroplasty
Bone conserving hip arthroplastyBone conserving hip arthroplasty
Bone conserving hip arthroplasty
Apollo Hospitals
 
Management of neglected monteggia fracture
Management of neglected monteggia fractureManagement of neglected monteggia fracture
Management of neglected monteggia fracture
Raul Bhardwaj
 
Fracture both forearm team v
Fracture both forearm team vFracture both forearm team v
Fracture both forearm team v
Reza Fahlevi
 
Comparative study of functional outcome of lateral locking plate fixation an...
Comparative study of functional outcome of  lateral locking plate fixation an...Comparative study of functional outcome of  lateral locking plate fixation an...
Comparative study of functional outcome of lateral locking plate fixation an...
Om Patil
 
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...
iosrjce
 
Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...
Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...
Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...
SSR Institute of International Journal of Life Sciences
 
Silver jubilee purple
Silver jubilee purpleSilver jubilee purple
Silver jubilee purple
navinthakkar
 
Internal fixation of fractures of the capitellum and trochlea - Retrospective...
Internal fixation of fractures of the capitellum and trochlea - Retrospective...Internal fixation of fractures of the capitellum and trochlea - Retrospective...
Internal fixation of fractures of the capitellum and trochlea - Retrospective...
Apollo Hospitals
 
knee arthroplasty handbook
knee arthroplasty handbookknee arthroplasty handbook
knee arthroplasty handbook
Adrián Cesar
 
Knee Sports for PostGrad Orth Course 2017
Knee Sports for PostGrad Orth Course 2017Knee Sports for PostGrad Orth Course 2017
Knee Sports for PostGrad Orth Course 2017
Professor Deiary Kader
 
Total shoulder arthroplasty and reverse TSA - Hussain Algawahmed
Total shoulder arthroplasty and reverse TSA - Hussain AlgawahmedTotal shoulder arthroplasty and reverse TSA - Hussain Algawahmed
Total shoulder arthroplasty and reverse TSA - Hussain Algawahmed
HussainAlgawahmedMBB
 
98th publication sjm- 3rd name
98th publication  sjm- 3rd name98th publication  sjm- 3rd name
98th publication sjm- 3rd name
CLOVE Dental OMNI Hospitals Andhra Hospital
 
39th publication iosr jdms - 1st name
39th publication   iosr jdms - 1st name39th publication   iosr jdms - 1st name
39th publication iosr jdms - 1st name
CLOVE Dental OMNI Hospitals Andhra Hospital
 
Treatment planning
Treatment planningTreatment planning
Treatment planning
Louran Dental Care
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repair
SoulderPain
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repair
SoulderPain
 
Sequencing in panfacial trauma
Sequencing in panfacial traumaSequencing in panfacial trauma
Sequencing in panfacial trauma
shivani gaba
 
arun ppt elbow bhilwara1.pptx
arun ppt elbow bhilwara1.pptxarun ppt elbow bhilwara1.pptx
arun ppt elbow bhilwara1.pptx
ArunSharma136969
 

Similar to The Role of Prosthetic Replacement in the Management of Comminuted Radial Head Fractures (20)

An isolated posterior dislocation of radial head in adults - A rare injury: A...
An isolated posterior dislocation of radial head in adults - A rare injury: A...An isolated posterior dislocation of radial head in adults - A rare injury: A...
An isolated posterior dislocation of radial head in adults - A rare injury: A...
 
An isolated posterior dislocation of radial head in adults – A rare injury: A...
An isolated posterior dislocation of radial head in adults – A rare injury: A...An isolated posterior dislocation of radial head in adults – A rare injury: A...
An isolated posterior dislocation of radial head in adults – A rare injury: A...
 
Bone conserving hip arthroplasty
Bone conserving hip arthroplastyBone conserving hip arthroplasty
Bone conserving hip arthroplasty
 
Management of neglected monteggia fracture
Management of neglected monteggia fractureManagement of neglected monteggia fracture
Management of neglected monteggia fracture
 
Fracture both forearm team v
Fracture both forearm team vFracture both forearm team v
Fracture both forearm team v
 
Comparative study of functional outcome of lateral locking plate fixation an...
Comparative study of functional outcome of  lateral locking plate fixation an...Comparative study of functional outcome of  lateral locking plate fixation an...
Comparative study of functional outcome of lateral locking plate fixation an...
 
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...
Segmental Fractures of the Forearm- Outcome Analysis of Various Management St...
 
Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...
Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...
Evaluation of Results of Intramedullary Fixation of Paediatric Fracture Shaft...
 
Silver jubilee purple
Silver jubilee purpleSilver jubilee purple
Silver jubilee purple
 
Internal fixation of fractures of the capitellum and trochlea - Retrospective...
Internal fixation of fractures of the capitellum and trochlea - Retrospective...Internal fixation of fractures of the capitellum and trochlea - Retrospective...
Internal fixation of fractures of the capitellum and trochlea - Retrospective...
 
knee arthroplasty handbook
knee arthroplasty handbookknee arthroplasty handbook
knee arthroplasty handbook
 
Knee Sports for PostGrad Orth Course 2017
Knee Sports for PostGrad Orth Course 2017Knee Sports for PostGrad Orth Course 2017
Knee Sports for PostGrad Orth Course 2017
 
Total shoulder arthroplasty and reverse TSA - Hussain Algawahmed
Total shoulder arthroplasty and reverse TSA - Hussain AlgawahmedTotal shoulder arthroplasty and reverse TSA - Hussain Algawahmed
Total shoulder arthroplasty and reverse TSA - Hussain Algawahmed
 
98th publication sjm- 3rd name
98th publication  sjm- 3rd name98th publication  sjm- 3rd name
98th publication sjm- 3rd name
 
39th publication iosr jdms - 1st name
39th publication   iosr jdms - 1st name39th publication   iosr jdms - 1st name
39th publication iosr jdms - 1st name
 
Treatment planning
Treatment planningTreatment planning
Treatment planning
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repair
 
Rotator cuff-repair
Rotator cuff-repairRotator cuff-repair
Rotator cuff-repair
 
Sequencing in panfacial trauma
Sequencing in panfacial traumaSequencing in panfacial trauma
Sequencing in panfacial trauma
 
arun ppt elbow bhilwara1.pptx
arun ppt elbow bhilwara1.pptxarun ppt elbow bhilwara1.pptx
arun ppt elbow bhilwara1.pptx
 

More from Apollo Hospitals

Movement disorders: A complication of chronic hyperglycemia? A case report
Movement disorders: A complication of chronic hyperglycemia? A case reportMovement disorders: A complication of chronic hyperglycemia? A case report
Movement disorders: A complication of chronic hyperglycemia? A case report
Apollo Hospitals
 
Malignant Mixed Mullerian Tumor – Case Reports and Review Article
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleMalignant Mixed Mullerian Tumor – Case Reports and Review Article
Malignant Mixed Mullerian Tumor – Case Reports and Review Article
Apollo Hospitals
 
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...
Apollo Hospitals
 
Improved Patient Satisfaction At Apollo – A Case Study
Improved Patient Satisfaction At Apollo – A Case StudyImproved Patient Satisfaction At Apollo – A Case Study
Improved Patient Satisfaction At Apollo – A Case Study
Apollo Hospitals
 
Breast Cancer in Young Women and its Impact on Reproductive Function
Breast Cancer in Young Women and its Impact on Reproductive FunctionBreast Cancer in Young Women and its Impact on Reproductive Function
Breast Cancer in Young Women and its Impact on Reproductive Function
Apollo Hospitals
 
Turner's Syndrome
Turner's SyndromeTurner's Syndrome
Turner's Syndrome
Apollo Hospitals
 
Hypothyroidism in Pregnancy
Hypothyroidism in PregnancyHypothyroidism in Pregnancy
Hypothyroidism in Pregnancy
Apollo Hospitals
 
Adult Growth Hormone Deficiency
Adult Growth Hormone DeficiencyAdult Growth Hormone Deficiency
Adult Growth Hormone Deficiency
Apollo Hospitals
 
Bone Health Issues in Thalassemia
Bone Health Issues in ThalassemiaBone Health Issues in Thalassemia
Bone Health Issues in Thalassemia
Apollo Hospitals
 
Radiopaque Shadows in the Abdomen
Radiopaque Shadows in the AbdomenRadiopaque Shadows in the Abdomen
Radiopaque Shadows in the Abdomen
Apollo Hospitals
 
Laparoscopic Excision of Foregut Duplication Cyst of Stomach
Laparoscopic Excision of Foregut Duplication Cyst of StomachLaparoscopic Excision of Foregut Duplication Cyst of Stomach
Laparoscopic Excision of Foregut Duplication Cyst of Stomach
Apollo Hospitals
 
Occupational Blood Borne Infections: Prevention is Better than Cure
Occupational Blood Borne Infections: Prevention is Better than CureOccupational Blood Borne Infections: Prevention is Better than Cure
Occupational Blood Borne Infections: Prevention is Better than Cure
Apollo Hospitals
 
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...
Apollo Hospitals
 
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...
Apollo Hospitals
 
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Apollo Hospitals
 
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?
Apollo Hospitals
 
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...
Apollo Hospitals
 
Unusual Manifestations of Dengue Fever
Unusual Manifestations of Dengue FeverUnusual Manifestations of Dengue Fever
Unusual Manifestations of Dengue Fever
Apollo Hospitals
 
An unusual cause of dysphagia
An unusual cause of dysphagiaAn unusual cause of dysphagia
An unusual cause of dysphagia
Apollo Hospitals
 
Pediatric Liver Transplantation
Pediatric Liver TransplantationPediatric Liver Transplantation
Pediatric Liver Transplantation
Apollo Hospitals
 

More from Apollo Hospitals (20)

Movement disorders: A complication of chronic hyperglycemia? A case report
Movement disorders: A complication of chronic hyperglycemia? A case reportMovement disorders: A complication of chronic hyperglycemia? A case report
Movement disorders: A complication of chronic hyperglycemia? A case report
 
Malignant Mixed Mullerian Tumor – Case Reports and Review Article
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleMalignant Mixed Mullerian Tumor – Case Reports and Review Article
Malignant Mixed Mullerian Tumor – Case Reports and Review Article
 
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...
 
Improved Patient Satisfaction At Apollo – A Case Study
Improved Patient Satisfaction At Apollo – A Case StudyImproved Patient Satisfaction At Apollo – A Case Study
Improved Patient Satisfaction At Apollo – A Case Study
 
Breast Cancer in Young Women and its Impact on Reproductive Function
Breast Cancer in Young Women and its Impact on Reproductive FunctionBreast Cancer in Young Women and its Impact on Reproductive Function
Breast Cancer in Young Women and its Impact on Reproductive Function
 
Turner's Syndrome
Turner's SyndromeTurner's Syndrome
Turner's Syndrome
 
Hypothyroidism in Pregnancy
Hypothyroidism in PregnancyHypothyroidism in Pregnancy
Hypothyroidism in Pregnancy
 
Adult Growth Hormone Deficiency
Adult Growth Hormone DeficiencyAdult Growth Hormone Deficiency
Adult Growth Hormone Deficiency
 
Bone Health Issues in Thalassemia
Bone Health Issues in ThalassemiaBone Health Issues in Thalassemia
Bone Health Issues in Thalassemia
 
Radiopaque Shadows in the Abdomen
Radiopaque Shadows in the AbdomenRadiopaque Shadows in the Abdomen
Radiopaque Shadows in the Abdomen
 
Laparoscopic Excision of Foregut Duplication Cyst of Stomach
Laparoscopic Excision of Foregut Duplication Cyst of StomachLaparoscopic Excision of Foregut Duplication Cyst of Stomach
Laparoscopic Excision of Foregut Duplication Cyst of Stomach
 
Occupational Blood Borne Infections: Prevention is Better than Cure
Occupational Blood Borne Infections: Prevention is Better than CureOccupational Blood Borne Infections: Prevention is Better than Cure
Occupational Blood Borne Infections: Prevention is Better than Cure
 
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...
 
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...
 
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
 
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?
 
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...
 
Unusual Manifestations of Dengue Fever
Unusual Manifestations of Dengue FeverUnusual Manifestations of Dengue Fever
Unusual Manifestations of Dengue Fever
 
An unusual cause of dysphagia
An unusual cause of dysphagiaAn unusual cause of dysphagia
An unusual cause of dysphagia
 
Pediatric Liver Transplantation
Pediatric Liver TransplantationPediatric Liver Transplantation
Pediatric Liver Transplantation
 

Recently uploaded

Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga
 
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfNAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
Rahul Sen
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Get New Sim
 
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdfOphthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
MuhammadMuneer49
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
HongBiThi1
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
SIVAVINAYAKPK
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
Gokuldas Hospital
 
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticalsacne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
MuskanShingari
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
Dr. Nikhilkumar Sakle
 
What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?
Healthmedsrx.com
 
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and SynonymsGiloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and Synonyms
Planet Ayurveda
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Chulalongkorn Allergy and Clinical Immunology Research Group
 
How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.
Gokuldas Hospital
 
Acute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdfAcute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdf
Jim Jacob Roy
 
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
ayushrajshrivastava7
 
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Call Girls In Mumbai +91-7426014248 High Profile Call Girl MumbaiCall Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Mobile Problem
 
Patellar Instability: Diagnosis Management
Patellar Instability: Diagnosis  ManagementPatellar Instability: Diagnosis  Management
Patellar Instability: Diagnosis Management
Dr Nitin Tyagi
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Kanhu Charan
 
SENSORY NEEDS B.SC. NURSING SEMESTER II.
SENSORY NEEDS B.SC. NURSING SEMESTER II.SENSORY NEEDS B.SC. NURSING SEMESTER II.
SENSORY NEEDS B.SC. NURSING SEMESTER II.
KULDEEP VYAS
 

Recently uploaded (20)

Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
 
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfNAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
 
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdfOphthalmic drugs latest. Xxxxxxzxxxxxx.pdf
Ophthalmic drugs latest. Xxxxxxzxxxxxx.pdf
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
Nano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory projectNano-gold for Cancer Therapy chemistry investigatory project
Nano-gold for Cancer Therapy chemistry investigatory project
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
 
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticalsacne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
 
Pharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and AntagonistPharmacology of 5-hydroxytryptamine and Antagonist
Pharmacology of 5-hydroxytryptamine and Antagonist
 
What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?
 
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and SynonymsGiloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and Synonyms
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
 
How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.
 
Acute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdfAcute Gout Care & Urate Lowering Therapy .pdf
Acute Gout Care & Urate Lowering Therapy .pdf
 
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
Full Handwritten notes of RA by Ayush Kumar M pharm - Al ameen college of pha...
 
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Call Girls In Mumbai +91-7426014248 High Profile Call Girl MumbaiCall Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
Call Girls In Mumbai +91-7426014248 High Profile Call Girl Mumbai
 
Patellar Instability: Diagnosis Management
Patellar Instability: Diagnosis  ManagementPatellar Instability: Diagnosis  Management
Patellar Instability: Diagnosis Management
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
 
SENSORY NEEDS B.SC. NURSING SEMESTER II.
SENSORY NEEDS B.SC. NURSING SEMESTER II.SENSORY NEEDS B.SC. NURSING SEMESTER II.
SENSORY NEEDS B.SC. NURSING SEMESTER II.
 

The Role of Prosthetic Replacement in the Management of Comminuted Radial Head Fractures

  • 1. The Role of Prosthetic Replacement in the Management of Comminuted Radial Head Fractures
  • 2. Apollo Medicine 2012 December Volume 9, Number 4; pp. 336e338 Case Report The role of prosthetic replacement in the management of comminuted radial head fractures A. Mohan Krishnaa, N. Somasekhar Reddyb,* ABSTRACT A displaced and badly comminuted fracture of the radial head is part of a complex instability injury of 3 joints namely elbow, radio-ulnar and wrist joints. If it is associated with Mason type IV and Essex Lopresti injury to forearm, simple excision of the radial head may lead to instability of the elbow joint and painfully restricted movements of the wrist. Management should be aimed at achieving the normal anatomy so that the function of elbow, radio-ulnar and wrist joints will be restored to a satisfactory level. We report the medium term result of a patient who had prosthetic replacement of radial head. Our patient in this case report was informed, that the details of the management would be submitted for publication. Copyright © 2012, Indraprastha Medical Corporation Ltd. All rights reserved. Keywords: Radial head fracture, Radial head prosthesis, Fracture dislocation of elbow, Radial head replacement, Radial head fracture with DRUJ instability CASE REPORT A 30-year-old gentleman was admitted following a road traffic accident with injury to his right upper limb. He had an elbow deformity with pain over forearm down to the wrist. He has mild fullness over volar aspect of the forearm with tenderness over the dorsum of the distal radioulnar joint and wrist joints with limitation of movements. X-rays confirmed dislocation of the elbow joint with a comminuted, displaced fracture of the radial head and fracture of the tip of the coronoid process. There was no gross dislocation at the distal radio-ulnar joint on the X-ray (Fig. 1). Surgery was done under brachial block. Dislocation was first reduced. Radial head was exposed through a postero lateral approach. It was found to be too comminuted to fix and was excised. There was about 3e5 mm of linear translatory movement between the radius and ulna confirming the axial forearm instability. Then the radial head was a recreated using the excised fragments. It is very important for two reasons. One is to make sure that all the broken pieces were removed. The second reason is to size the appropriate prosthetic component. Radial neck was prepared to get a uniform cut and the medullary canal was prepared with a gouge and a narrow pointed rasp. Sometimes a high-speed burr is necessary to shape the medullary canal to accept the stem of the trial component. The preparation of the medullary canal can be tedious as one cannot hammer the prosthesis in to the canal due to the high risk of fracture of radial neck and shaft. I used chrome cobalt uncemented prosthesis (Corin) (Fig. 2). This implant comes in three diameters and each diameter comes with a thick and a thin head, making a total of 6 sizes. When the natural radial head diameter falls in between the prosthetic sizes it is advisable to go for the smaller prosthetic head. This is to prevent over stuffing the proximal radio-ulnar joint. But the thickness of the head should be maintained as close to the natural as Consultant Orthopaedic Surgeon, bSenior Consultant Orthopaedic Surgeon, Apollo Hospitals, Hyderabad, India. Corresponding author. Room No. 957, Apollo Hospitals, Jubilee Hills, Hyderabad 500 033, India. Tel.: þ91 98480 25355, email: nreddy12@ yahoo.com Received: 4.7.2012; Accepted: 4.8.2012; Available online 21.8.2012 Copyright Ó 2012, Indraprastha Medical Corporation Ltd. All rights reserved. * http://dx.doi.org/10.1016/j.apme.2012.08.002
  • 3. The role of prosthetic replacement in the management of comminuted radial head fractures Case Report 337 DRUJ or wrist joint. At his next visit at 18 months following surgery he has full pronation with marginal improvement in flexion and extension. X-ray of the elbow did not show any evidence of prosthesis loosening or erosion of the capitellum. DISCUSSION Fig. 1 Pre-operative X-ray showing fracture dislocation of elbow joint. possible by inserting less or more of the prosthetic stem in to the medullary canal to appropriately support the capitellum. There was no valgus instability after reducing the radial head suggesting the integrity of medial collateral ligament. At 90 of flexion elbow joint was stable and hence no attempt was made to fix the small fragment of coronoid process. Elbow was immobilised at about 100 of flexion and forearm in full supination to maintain maximum interosseous space. Active and active assisted movements were started after 3 weeks. Four months following the procedure, patient regained 15 short of full extension with terminal restriction of flexion. There was terminal restriction of both supination and pronation. Elbow joint was stable and he has no pain at Resection of the radial head for simple fractures has been shown to give satisfactory long term results.1,2 However unrecognised complex injuries with elbow or axial forearm instability may be responsible for unstable elbow, proximal migration of radius, with or without chronic wrist pain.3 This instability is a major concern in young and active people whereas in a relatively sedentary and elderly people it may not cause any significant problem for the day to day activities. Silicon radial head prosthesis did not offer rigid stability. Proximal migration of the radius progressed with break-up of the implant and subsequent synovitis.4,5 Metallic radial head offered better stability against valgus forces at elbow and axial forearm instability.6e8 However over stuffing of the radio capitellar joint must be avoided, as it may produce capitellar erosion especially when done as a late reconstructive procedure for chronic wrist pain.9 We recommend this procedure strongly in young people to avoid long term consequences of elbow, radio-ulnar and wrist joint instabilities. Loosening of the stem as a major complication was not reported in the literature when the procedure was done in young people. We believe that for any reason if the prosthesis has to be explanted after a period of 6e12 months it may not lead to any instabilities mentioned above as the interosseous membrane and other soft tissues would have got stabilised by then to a large extent preventing proximal migration of radial shaft. Even though the role of radial head prosthesis in stabilising the elbow and axial forearm instability seems well proven, it is being used less often mainly because of lack of awareness of secondary instability and non-availability of radial head prosthesis. CONFLICTS OF INTEREST All authors have none to declare. REFERENCES Fig. 2 Post-operative X-ray showing radial head replacement. 1. Goldberg I, Peylan J, Yosipovitch Z. Late results of excision of the radial head for an isolated closed fracture. J Bone Joint Surg Am. 1986;68:675e679.
  • 4. 338 Apollo Medicine 2012 December; Vol. 9, No. 4 2. Morrey BF, Chao EY, Hui FC. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am. 1979;61:63e68. 3. Sowa DT, Hotchkiss RN, Welland AJ. Symptomatic proximal translation of the radius following radial head resection. Clin Orthop. 1995;317:106e113. 4. Morrey BF, Askew L, Chao EY. Silastic prosthesis replacement for the radial head. J Bone Joint Surg Am. 1981;63:454e458. 5. Valderwilde RS, Morrey BF, Melberg MW, Vinh TN. Inflammatory arthritis after failure of silicon rubber replacement of the radial head. J Bone Joint Surg Br. 1994;76:78e81. 6. Moro JK, Werler J, MacDermid JC, Patterson SD, King GJ. Arthroplasty with a metal radial head for unreconstructable Mohan Krishna and Somasekhar Reddy fractures of the radial head. J Bone Joint Surg Am. 2001;83: 1201e1211. 7. Bain GI, Ashwood N, Baird R, Unni R. Management of Mason type III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. J Bone Joint Surg Am. 2005;87:65e76. 8. Grewal Ruby, Dermid Joy C, Faber Kenneth J, Drosdowech Darren S, King Graham JW. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. J Bone Joint Surg Am. 2006;88:2192e2200. 9. Van Riet Roger P, Van Glabbeek Francis, Verborgt Olivier, Gielen Jan. Capitellar erosion caused by metal radial head prosthesis. J Bone Joint Surg Am. 2004;86:1061e1064. Erratum to “Colour Doppler ultrasound in controlled ovarian stimulation with intrauterine insemination” [Apollo Med 9 (3) (2012) 252e263] Kavita Bhadauriaa,*, Reeti Sahnib, Sohani Vermab, Payal Q. Khatric The above mentioned article published in the September issue is an Original Article, but was published as a Case Report by mistake. The journal regrets for this error. DOI of original article: 10.1016/j.apme.2012.07.014. a Resident, bSenior Consultant, cAssociate Consultant, Department of Radiodiagnosis and AARU, Indraprashta Apollo Hospitals, New Delhi 110076, India. * Corresponding author. Copyright Ó 2012, Indraprastha Medical Corporation Ltd. All rights reserved. http://dx.doi.org/10.1016/j.apme.2012.11.001
  • 5. A o oh s i l ht:w wa o o o p a . m/ p l o p a : t / w .p l h s i lc l ts p / l ts o T ie: t s / ie. m/o p a A o o wt rht :t t r o H s i l p l t p /w t c ts l Y uu e ht:w wy uu ec m/p l h s i ln i o tb : t / w . tb . a o o o p a i a p/ o o l ts d F c b o : t :w wfc b o . m/h A o o o p a a e o k ht / w . e o k o T e p l H s i l p/ a c l ts Si s ae ht:w wsd s aen t p l _ o p a l e h r: t / w .i h r.e/ o o H s i l d p/ le A l ts L k d : t :w wl k d . m/ mp n /p l -o p a i e i ht / w . e i c c a y o oh s i l n n p/ i n no o a l ts Bo : t :w wl s l e l . / l ht / w . t a h a hi g p/ e tk t n