- Discussion:
-
radial head frx plus
dislocation of distal RU joint (&
interosseous membrane disruption);
- mechanism: fall from height;
- in this type of frx, radius will also migrate proximally if radial head is excised;
- if injury is not found when it is acute, pt may develop severe wrist pain from radial migration and subluxation, of upto 5-6 mm;
- there may be loss of forearm pronation, supination, and extension;
- late reconstruction( > 4 weeks) of radial instability yields poor results;
- Exam:
- distal radio-ulnar joint tenderness is most sensitive test to diagnose injury;
- Radiographs:
-
lateral view of pronated wrist may show ulna to be dorsally subluxated;
- Management:
-
RU joint:
- full supination of the forearm usually results in reduction of
RU joint dislocation;
- in order to maintain inadequate radial length & RU joint reduction, consider pinning of RU joint for 6 weeks to allow for anatomic
healing of
interosseous membrane;
-
radial head:
- ORIF is indicated unless comminution precludes adequate fixation;
-
type III radial head fracture;
-
Kocher approach
-
radial head implants:
- indicated when ORIF is not possible;
- avoid using silicone prosthesis for the Essex Lopresti injury since this material is inadequate to withstand the compression
forces across the radiocapitellar joint;
- besides migration of the radius, implant fracture, and synovitis are common complications;
- avoid radial head excision:
-
excision of radial head will result in proximal migration of radius, along w/ severe wrist pain (ulnacarpal impingement) as well as elbow pain;
Radial head fractures and their effect on the distal radioulnar joint. A rationale for treatment.
Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited.
Fractures of the radial head with distal radioulnar dislocation; Essex-Lopresti P. JBJS 33-B, 1951. p 244-250.
The Use of Frozen Allograft Radial Head Replacement for Treatment of Established Symptomatic Proximal translation of the Radius: Preliminary Experience in Five Cases.
RM Szabo MD MPH, RN Hotchkiss MD, RR Slater Jr MD. J. Hand Surg. 22-A, 269-278. 1997.
Primary Replacement of the fractured radial head with a metal prosthesis.
Knight D, Rymaszewski L, Amis A, Miller J. JBJS 75-B: 572-576. 1993.
