Radial Head Fractures and Elbow Instability - Ian McDermott 14/11/2002

- Radial Head # occurs in ~5-10% of elbow dislocations

- Also, ~5-10% of radial head #s are assoc with elbow dislocations

- Radial head #s assoc with elbow dislocation have a worse prognosis cf isolated radial head #s

MASON ( Br J Surg 1954) - Radial Head # Classification:

Type I               <2mm displacement

Type II              >2mm and involving >30% of radial head

Type III             Comminuted

Type IV            #rad head in assoc with elbow dislocation

                        (Johnson, Ulster Med J , 1962)

  20% incidence of myositis ossificans in radial head #s assoc with elbow disloc

Gaston, Am J Surg 1949: advocated early excision of radial head & fragments

            In a series of 22 patients -> no cases of M.O.

            Good results is all patients operated on within 12 hours of injury

            5/20 good results if operation >12 hours after injury

- Reiterated by Thompson, Clin Orth 50, 1967

- McLaughlin, Surg Clin North Am 1955 described it as 'Orthopaedic Emergency'

- Adler, J Trauma 1964: better to treat non-operatively with early motion. Only operate if there is an obvious mechanical block to motion. If do perform surgery, then should be at < 24 hours.

- Morrey 1979, Morrey 1981, Swanson 1981 ---   Use silastic prosthesis

- Carn, CORR 209, 1986 showed that Silastic Prostheses deformed under load and did not bear any load through to the capitellum


Brief

MORREY                      1991                       CORR

Title

Valgus Instability of the elbow. A definition of primary and secondary restraints

Authors

Morrey BF, Tanaka S, An K

Reference

Clinical Orthopaedics 1991, 265: 187-195

SUMMARY

The comminuted radial head fracture without MCL instability should be treated by radial head excision without the need for an implant

Critique

6 cadaver specimens (didn't know age, gender, weight!). Anterior bundle of MCL is the primary restraint to valgus. If this is intact, then posterior bundle or radial are not important



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