Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Radial Head Fractures
Updated: Oct 4 2016

Radial Head Fx - Replacement

Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Template fracture

  • identify fracture pattern, displacement, comminution, and presence of dislocation

2

Execute surgical walkthrough

  • describe key steps of the operation verbally to attending prior to beginning of case.
  • description of potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • screws, headless screws and plating system

2

Room setup and equipment

  • c-arm perpendicular to OR table

3

Patient positioning

  • supine position
  • place affected extremity over arm bolster
  • arm should be in 90 degrees of flexion
  • place bump under ipsilateral scapula
  • place sterile tourniquet
G

Kocher Approach to the Elbow

1

Mark anatomic landmarks

  • palpate the radial head and the lateral epicondyle

2

Make 5cm posterolateral incision

  • make an oblique 5 cm incision starting from the posterolateral aspect of the lateral epicondyle to a point that is three fingerbreadths below the olecranon
  • this incision should be inline with the radial neck
  • divide the fascia in line with the skin incision

3

Identify the Kocher interval

  • interval between the anconeus and the ECU
  • this is distally identified by penetrating veins
  • use blunt dissection to develop the interval
  • visualize the ligamentous complex and joint capsule
  • pronate the arm to move the PIN nerve distally
H

Deep Dissection

1

Expose radiocapitellar joint

  • elevate the anconeus and ECU
  • reflect the anconeus posteriorly and the ECU anteriorly

2

Make arthrotomy

  • visualize the radial head fracture
I

Preparation of the Radial Head and Neck

1

Visualize the radial head

  • irrigate the wound and remove loose bodies

2

Excise the radial head and neck

  • remove the radial head and neck at a right angle to the medullary canal
  • this makes a smooth surface for seating of the radial head implant
  • ensure that complete excision has been performed with fluoroscopy

3

Evaluate the capitellum for chondral injuries or osteochondral injury

J

Size Radial Head Prosthesis

1

Template head size

  • reassemble the radial head
  • place radial head on sizing template
  • diameter of the prosthesis should be 2mm smaller than the outer diameter of the radial head that is excised
K

Trial and Place Implant

1

Place radial head implant

  • insert trial head onto the stem

2

Evaluate placement

  • check diameter, height, tracking and congruency of the prosthesis
  • the radial head prosthesis should articulate at the same height as the radial notch of the ulna
  • should also be 1 mm distal to the tip of the coronoid

3

Place Final Implant

4

Check Implant with Fluoroscopy

L

Evaluate Elbow Range of Motion and Stability

1

Check elbow flexion and extension

2

Check stability in various rotations of the elbolw

  • pronation
  • supination
  • neutral
N

Wound Closure

1

Irrigation and hemostasis

  • irrigate wounds thoroughly
  • deflate tourniquet (if elevated)
  • coagulate any bleeders carefully

2

Deep Closure

  • use 0-vicryl for deep closure

3

Superficial Closure

  • use 3-0 vicryl for subcutaneous closure
  • place subcutaneous drain
  • close skin with 3-0 nylon

4

Dressing and immediate immobilization

  • soft dressing (gauze, webril)
  • place in anterior splint in extension
  • sling for comfort
Postoperative Patient Care
Private Note