Zusammenfassung
Die Radiuskopfprothese stellt die Therapie der Wahl für nicht rekonstruierbare Radiuskopffrakturen dar. Solide Prothesen aus Metall oder Pyocarbon können unabhängig vom Design oder Verankerungsoptionen die Valgusstabilität des Ellenbogens wiederherstellen. Kurz- und mittelfristige Ergebnisse zeigen überwiegend gute und sehr gute Ergebnisse, ohne dass bisher wesentliche Unterschiede zwischen den verschiedenen Prothesenphilosophien ausgemacht werden können. Wichtig für das Erreichen eines guten Ergebnisses sind die korrekte Implantationstechnik unter Vermeidung eines „Overstuffing“ und die korrekte Einschätzung der ligamentären Begleitverletzungen. Dieser Artikel diskutiert die anatomischen und biomechanischen Grundlagen der Radiuskopfendoprothetik, die Operationstechnik und die radiologische Diagnostik des „Overstuffing“.
Abstract
Radial head arthroplasty is the treatment of choice for non-reconstructble radial head fractures. Solid prostheses made of metal or pyocarbon can restore valgus stability of the elbow independent of design or stem fixation. Short-term and mid-term results show mostly good to excellent results without any evident differences between the different prosthesis philosophies. In ordert to obtain good results it is important to implant the prosthesis correctly without overfilling and to judge concomitant ligament injuries correctly. This article discusses the anatomical and biomechanical basis of radial head arthroplasty as well as the surgical technique and radiological diagnosis of overfilling.
Literatur
Alnot JY, Katz V, Hardy P (2003) GUEPAR radial head prosthesis for recent and old fractures: a series of 22 cases. Rev Chir Orthop Reparatrice Appar Mot 89:304–309
Amis AA, Dowson D, Wright V (1980) Elbow joint force predictions for some strenuous isometric actions. J Biomech 13:765–775
Arbter D, Piatek S, Probst A et al (2012) Results after Judet radial head prosthesis for non-reconstructable radial head fractures. Unfallchirurg 115:1000–1008
Ashwood N, Bain GI, Unni R (2004) Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. J Bone Joint Surg Am 86:274–280
Athwal GS, Rouleau DM, Macdermid JC et al (2011) Contralateral elbow radiographs can reliably diagnose radial head implant overlengthening. J Bone Joint Surg Am 93:1339–1346
Bain GI, Ashwood N, Baird R et al (2005) Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization. Surgical technique. J Bone Joint Surg Am 87(Suppl 1):136–147
Beingessner DM, Dunning CE, Gordon KD et al (2004) The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 86:1730–1739
Beredjiklian PK, Nalbantoglu U, Potter HG et al (1999) Prosthetic radial head components and proximal radial morphology: a mismatch. J Shoulder Elbow Surg 8:471–475
Berschback JC, Lynch TS, Kalainov DM et al (2013) Clinical and radiographic comparisons of two different radial head implant designs. J Shoulder Elbow Surg (Epub ahead of print)
Burkhart KJ, Mattyasovszky SG, Runkel M et al (2011) Clinical and radiological results after Judet’s radial head prosthesis. Obere Extremität 6:108–114
Burkhart KJ, Mattyasovszky SG, Runkel M et al (2010) Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg 19:965–972
Burkhart KJ, Mueller LP, Krezdorn D et al (2007) Stability of radial head and neck fractures: a biomechanical study of six fixation constructs with consideration of three locking plates. J Hand Surg Am 32:1569–1575
Burkhart KJ, Nowak TE, Appelmann P et al (o J) Screw fixation of radial head fractures: compression screw versus lag screw – a biomechanical comparison. Injury 41:963–967
Burkhart KJ, Nowak TE, Kim YJ et al (2011) Anatomic fit of six different radial head plates: comparison of precontoured low-profile radial head plates. J Hand Surg Am 36:617–624
Burkhart KJ, Wegmann K, Ries C et al (2012) Treatment of radial head and neck fractures: in favor of anatomical reconstruction. Eur J Trauma Emerg Surg 38:593–603
Businger A, Ruedi TP, Sommer C (2009) On-table reconstruction of comminuted fractures of the radial head. Injury 41(6):583–588
Chanlalit C, Shukla DR, Fitzsimmons JS et al (2012) The biomechanical effect of prosthetic design on radiocapitellar stability in a terrible triad model. J Orthop Trauma 26:539–544
Chanlalit C, Shukla DR, Fitzsimmons JS et al (2011) Influence of prosthetic design on radiocapitellar concavity-compression stability. J Shoulder Elbow Surg 20:885–890
Chanlalit C, Shukla DR, Fitzsimmons JS et al (2011) Radiocapitellar stability: the effect of soft tissue integrity on bipolar versus monopolar radial head prostheses. J Shoulder Elbow Surg 20:219–225
Chapman CB, Su BW, Sinicropi SM et al (2006) Vitallium radial head prosthesis for acute and chronic elbow fractures and fracture-dislocations involving the radial head. J Shoulder Elbow Surg 15:463–473
Davidson PA, Moseley JB Jr, Tullos HS (1993) Radial head fracture. A potentially complex injury. Clin Orthop Relat Res 297:224–230
Doornberg JN, Parisien R, Van Duijn PJ et al (2007) Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. J Bone Joint Surg Am 89:1075–1080
Dotzis A, Cochu G, Mabit C et al (2006) Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis. J Bone Joint Surg Br 88:760–764
Flinkkila T, Kaisto T, Sirnio K et al (2012) Short- to mid-term results of metallic press-fit radial head arthroplasty in unstable injuries of the elbow. J Bone Joint Surg Br 94:805–810
Frank SG, Grewal R, Johnson J et al (2009) Determination of correct implant size in radial head arthroplasty to avoid overlengthening. J Bone Joint Surg Am 91:1738–1746
Giannicola G, Sacchetti FM, Postacchini R et al (2010) Hemilateral resurfacing arthroplasty in posttraumatic degenerative elbow resulting from humeral capitellum malunion. J Shoulder Elbow Surg 19:12–17
Grewal R, Macdermid JC, Faber KJ et al (2006) Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J Bone Joint Surg Am 88:2192–2200
Harrington IJ, Sekyi-Otu A, Barrington TW et al (2001) The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review. J Trauma 50:46–52
Hausmann JT, Vekszler G, Breitenseher M et al (2009) Mason type-I radial head fractures and interosseous membrane lesions – a prospective study. J Trauma 66:457–461
Heijink A, Morrey BF, Cooney WP 3rd (2008) Radiocapitellar hemiarthroplasty for radiocapitellar arthritis: a report of three cases. J Shoulder Elbow Surg 17:12–15
Holmenschlager F, Halm JP, Winckler S (2002) Fresh fractures of the radial head: results with the Judet prosthesis. Rev Chir Orthop Reparatrice Appar Mot 88:387–397
Ikeda M, Yamashina Y, Kamimoto M et al (2003) Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates. J Bone Joint Surg Br 85:1040–1044
Itamura J, Roidis N, Mirzayan R et al (2005) Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg 14:421–424
Judet T, Massin P, Bayeh PJ (1994) Radial head prosthesis with floating cup in recent and old injuries of the elbow: preliminary results. Rev Chir Orthop Reparatrice Appar Mot 80:123–130
Katthagen JC, Jensen G, Lill H et al (2013) Monobloc radial head prostheses in complex elbow injuries: results after primary and secondary implantation. Int Orthop 37:631–639
Knight DJ, Rymaszewski LA, Amis AA et al (1993) Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br 75:572–576
Koslowsky TC, Mader K, Dargel J et al (2007) Reconstruction of a Mason type-III fracture of the radial head using four different fixation techniques. An experimental study. J Bone Joint Surg Br 89:1545–1550
Koslowsky TC, Mader K, Gausepohl T et al (2007) Reconstruction of Mason type-III and type-IV radial head fractures with a new fixation device: 23 patients followed 1–4 years. Acta Orthop 78:151–156
Kuhn S, Burkhart KJ, Schneider J et al (2012) The anatomy of the proximal radius: implications on fracture implant design. J Shoulder Elbow Surg 21:1247–1254
Lamas C, Castellanos J, Proubasta I et al (2011) Comminuted radial head fractures treated with pyrocarbon prosthetic replacement. Hand (N Y) 6:27–33
Liew VS, Cooper IC, Ferreira LM et al (2003) The effect of metallic radial head arthroplasty on radiocapitellar joint contact area. Clin Biomech (Bristol, Avon) 18:115–118
Lim YJ, Chan BK (2008) Short-term to medium-term outcomes of cemented Vitallium radial head prostheses after early excision for radial head fractures. J Shoulder Elbow Surg 17:307–312
Moro JK, Werier J, Macdermid JC et al (2001) Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am 83:1201–1211
Morrey BF (2009) Prosthetic radial head replacement. In: Morrey BF, Sanchez-Sotelo J (Hrsg) The elbow and it’s disorders. Saunders Elsevier, Philadelphia, pp 381–388
Morrey BF, An KN (2005) Stability of the elbow: osseous constraints. J Shoulder Elbow Surg 14:174–178
Morrey BF, An KN, Stormont TJ (1988) Force transmission through the radial head. J Bone Joint Surg Am 70:250–256
Morrey BF, Tanaka S, An KN (1991) Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 265:187–195
Moungondo F, El Kazzi W, Van Riet R et al (2010) Radiocapitellar joint contacts after bipolar radial head arthroplasty. J Shoulder Elbow Surg 19:230–235
Müller MC, Burger C, Striepens N et al (2008) Clinical results after replacement of comminuted radial head fractures (Mason III and IV) by the bipolar radial head prosthesis of Judet. Z Orthop Unfall 146:218–226
Pike JM, Athwal GS, Faber KJ et al (2009) Radial head fractures – an update. J Hand Surg Am 34:557–565
Pomianowski S, Morrey BF, Neale PG et al (2001) Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am 83:1829–1834
Popovic N, Djekic J, Lemaire R et al (2005) A comparative study between proximal radial morphology and the floating radial head prosthesis. J Shoulder Elbow Surg 14:433–440
Popovic N, Lemaire R, Georis P et al (2007) Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface. J Bone Joint Surg Am 89:2469–2476
Ring D, Quintero J, Jupiter JB (2002) Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 84-A:1811–1815
Rowland AS, Athwal GS, Macdermid JC et al (2007) Lateral ulnohumeral joint space widening is not diagnostic of radial head arthroplasty overstuffing. J Hand Surg Am 32:637–641
Ruan HJ, Fan CY, Liu JJ et al (2009) A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III. Int Orthop 33:249–253
Sarris IK, Kyrkos MJ, Galanis NN et al (2012) Radial head replacement with the MoPyC pyrocarbon prosthesis. J Shoulder Elbow Surg 21:1222–1228
Schneeberger AG, Sadowski MM, Jacob HA (2004) Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 86:975–982
Shore BJ, Mozzon JB, Macdermid JC et al (2008) Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty. J Bone Joint Surg Am 90:271–280
Shukla DR, Fitzsimmons JS, An KN et al (2012) Effect of stem length on prosthetic radial head micromotion. J Shoulder Elbow Surg 21:1559–1564
Smets S, Govaers K, Jansen N et al (2000) The floating radial head prosthesis for comminuted radial head fractures: a multicentric study. Acta Orthop Belg 66:353–358
Van Glabbeek F, Van Riet RP, Baumfeld JA et al (2004) Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg Am 86:2629–2635
Van Glabbeek F, Van Riet RP, Baumfeld JA et al (2005) The kinematic importance of radial neck length in radial head replacement. Med Eng Phys 27:336–342
Van Riet RP, Van Glabbeek F, De Weerdt W et al (2007) Validation of the lesser sigmoid notch of the ulna as a reference point for accurate placement of a prosthesis for the head of the radius: a cadaver study. J Bone Joint Surg Br 89:413–416
Van Riet RP, Van Glabbeek F, Neale PG et al (2004) Anatomical considerations of the radius. Clin Anat 17:564–569
Van Riet RP, Van Glabbeek F, Neale PG et al (2003) The noncircular shape of the radial head. J Hand Surg Am 28:972–978
Van Riet RP, Van Glabbeek F, Verborgt O et al (2004) Capitellar erosion caused by a metal radial head prosthesis. A case report. J Bone Joint Surg Am 86:1061–1064
Wick M, Lies A, Muller EJ et al (1998) Prostheses of the head of the radius. What outcome can be expected? Unfallchirurg 101:817–821
Yian E, Steens W, Lingenfelter E et al (2008) Malpositioning of radial head prostheses: an in vitro study. J Shoulder Elbow Surg 17:663–670
Zhao J, Yang S, Hu Y (2007) The early outcomes with titanium radial head implants in the treatment of radial head comminuted fractures. J Huazhong Univ Sci Technolog Med Sci 27:681–683
Einhaltung der ethischen Richtlinien
Interessenkonflikt. K.J. Burkhart gibt eine Referententätigkeit für Arthex, Tornier, Medartis und Reisekostenübernahme durch Sryker an. K. Wegmann gibt eine Referententätigkeit für Medartis an. L.P. Müller gibt eine Referententätigkeit für Tornier, Medartis und Stryker an. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Burkhart, K., Wegmann, K., Ries, C. et al. Endoprothetik der akuten Radiuskopffraktur. Unfallchirurg 116, 698–707 (2013). https://doi.org/10.1007/s00113-013-2412-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00113-013-2412-3