Evolve™ Modular Metallic Radial Head Arthroplasty

  • Graham J. W. King


Radial head fractures are the most common fracture of the elbow [1]. Undisplaced fractures or small (< 33% of radial head) minimally displaced fractures (< 2 mm) can be treated with early motion with an excellent outcome in the majority of patients [2, 3]. Small displaced fractures which cause painful crepitus or limited motion are managed with fragment excision if they are too small or osteopenic to be treated with open reduction and internal fixation (ORIF) [4, 5, 6]. Larger displaced fractures are typically managed with ORIF with good outcomes in most patients [7-11]. However, comminuted fractures that have three or more parts have faired poorly with ORIF [10]. These comminuted radial head fractures are generally treated with radial head excision, with or without radial head replacement. In the setting of an associated injury to the medial collateral, lateral collateral, or interosseous ligaments, radial head excision is contraindicated due to its important role as a valgus, varus and axial stabilizer [12, 13, 14].


Radial Head Medial Collateral Ligament Lateral Collateral Ligament Radial Head Fracture Annular Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    King GJ (2005) Fractures of the head of the radius. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW (eds), Green’s Operative Hand Surgery. Elsevier Churchill Livingstone, Philadelphia, pp 845–887Google Scholar
  2. 2.
    Holdsworth BJ, Clement DA, Rothwell PN (1987) Fractures of the radial head. The benefit of aspiration: a prospective controlled trial. Injury 18:44–47PubMedCrossRefGoogle Scholar
  3. 3.
    Mason ML (1954) Some observations on fracture of the head of the radius with a review of one hundred cases. Br J Surg 42:123–132PubMedCrossRefGoogle Scholar
  4. 4.
    Wexner SD, Goodwin C, Parkes JC et al (1985) Treatment of fractures of the radial head by partial excision. Orthop Rev 14:83–86Google Scholar
  5. 5.
    Murray RC (1940) Fractures of the head and neck of the radius. Br J Surg 27:106–118CrossRefGoogle Scholar
  6. 6.
    Castberg T, Thing E (1953) Treatment of fractures of the upper end of the radius. Acta Chir Scand 1051:62–69Google Scholar
  7. 7.
    Esser RD, Davis S, Taavao T (1995) Fractures of the radial head treated by internal fixation: Late results in 26 cases. J Orthop Trauma 9:318–323PubMedCrossRefGoogle Scholar
  8. 8.
    Geel CW, Palmer AK, Ruedi T, Leutenegger AF (1990) Internal fixation of proximal radial head fractures. J Orthop Trauma 4:270–274PubMedCrossRefGoogle Scholar
  9. 9.
    King GJ, Evans DC, Kellam JF (1991) Open reduction and internal fixation of radial head fractures. J Orthop Trauma 5:21–28PubMedGoogle Scholar
  10. 10.
    Ring D, Quintero J, Jupiter JB (2002) Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 84:1811–1815PubMedGoogle Scholar
  11. 11.
    Shmueli G, Herold HZ (1981) Compression screwing of displaced fractures of the head of the radius. J Bone Joint Surg Br 63:535–538Google Scholar
  12. 12.
    Roberts PH (1969) Dislocation of the elbow. Br J Surg 56:806–815PubMedCrossRefGoogle Scholar
  13. 13.
    Adler JB, Shaftan GW (1962) Radial head fractures, is excision necessary? J Trauma 4:115–136CrossRefGoogle Scholar
  14. 14.
    Johnston GW (1962) A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 31:51–56PubMedGoogle Scholar
  15. 15.
    Josefsson PO, Johnell O, Wendeberg B (1987) Ligamentous injuries in dislocations of the elbowjoint. Clin Orthop Relat Res 221:221–225PubMedGoogle Scholar
  16. 16.
    Davidson PA, Moseley Jr JB, Tullos HS (1993) Radial head fracture. A potentially complex injury. Clin Orthop Relat Res 297:224–230PubMedGoogle Scholar
  17. 17.
    Sellman DC, Seitz Jr WH, Postak PD, Greenwald AS (1995) Reconstructive strategies for radioulnar dissociation: A biomechanical study. J Orthop Trauma 9:516–522PubMedCrossRefGoogle Scholar
  18. 18.
    Pribyl CR, Rester MA, Cook SD et al (1986) The effect of the radial head excision and prosthetic radial head replacement on resisting valgus stress at the elbow. Orthopedics 9:723–726PubMedGoogle Scholar
  19. 19.
    King GJ, Zarzour ZD, Rath DA et al (1999) Metallic radial head arthroplasty improves valgus stability of the elbow. Clin Orthop Relat Res 368:114–125PubMedCrossRefGoogle Scholar
  20. 20.
    Gordon M, Bullough PG (1982) Synovial and osseous inflammation in failed silicone-rubber prostheses: a report of six cases. J Bone Joint Surg Am 64:574–580PubMedGoogle Scholar
  21. 21.
    Martinelli B (1985) Silicone-implant replacement arthroplasty in fractures of the radial head. A follow-up report. Bull Hosp Jt Dis Orthop Inst 45:158–161PubMedGoogle Scholar
  22. 22.
    Mayhall WS, Tiley FT, Paluska DJ (1981) Fracture of silastic radial-head prosthesis. Case report. J Bone Joint Surg Am 63:459–460PubMedGoogle Scholar
  23. 23.
    Trepman E, Ewald FC (1991) Early failure of silicone radial head implants in the rheumatoid elbow. A complication of silicone radial head implant arthroplasty. J Arthroplasty 6:59–65PubMedCrossRefGoogle Scholar
  24. 24.
    Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN (1994) Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg Br 76:78–81PubMedGoogle Scholar
  25. 25.
    Edwards GE, Rostrup O (1960) Radial head prosthesis in the management of radial head fractures. Can J Surg 3:153–155PubMedGoogle Scholar
  26. 26.
    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 50:46–52PubMedCrossRefGoogle Scholar
  27. 27.
    Harrington IJ, Tountas AA (1981) Replacement of the radial head in the treatment of unstable elbow fractures. Injury 12:405–412PubMedCrossRefGoogle Scholar
  28. 28.
    Judet T, Garreau DL, Piriou P, Charnley G (1996) A floating prosthesis for radial-head fractures. J Bone Joint Surg Br 78:244–249PubMedGoogle Scholar
  29. 29.
    Knight DJ, Rymaszewski LA, Amis AA, Miller JH (1993) Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br 75:572–576PubMedGoogle Scholar
  30. 30.
    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 83:1201–1211PubMedGoogle Scholar
  31. 31.
    Popovic N, Gillet P, Rodriguez A, Lemaire R (2000) Fracture of the radial head with associated elbow dislocation: Results of treatment using a floating radial head prosthesis. J Orthop Trauma 14:171–177PubMedCrossRefGoogle Scholar
  32. 32.
    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 66:353–358PubMedGoogle Scholar
  33. 33.
    Gupta GG, Lucas G, Hahn DL (1997) Biomechanical and computer analysis of radial head prostheses. J Shoulder Elbow Surg 6:37–48PubMedCrossRefGoogle Scholar
  34. 34.
    King GJ, Zarzour ZD, Patterson SD, Johnson JA (2001) An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplasty 16:112–116PubMedCrossRefGoogle Scholar
  35. 35.
    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 86:1730–1739PubMedGoogle Scholar
  36. 36.
    Johnson JA, Beingessner DM, Gordon KD et al (2005) Kinematics and stability of the fractured and implant reconstructed radial head. J Shoulder Elbow Surg 14:S195–S201CrossRefGoogle Scholar
  37. 37.
    Swanson AB, Jaeger SH, La Rochelle D (1981) Comminuted fractures of the radial head The role of silicone-implant replacement arthroplasty. J Bone Joint Surg Am 63:1039–1049PubMedGoogle Scholar
  38. 38.
    Carn RM, Medige J, Curtain D, Koenig A (1986) Silicone rubber replacement of the severely fractured radial head. Clin Orthop Relat Res 209:259–269PubMedGoogle Scholar
  39. 39.
    Beredjiklian PK, Nalbantoglu U, Potter HG, Hotchkiss RN (1999) Prosthetic radial head components and proximal radial morphology: a mismatch. J Shoulder Elbow Surg 8:471–475PubMedCrossRefGoogle Scholar
  40. 40.
    O’Driscoll SW, Morrey BF, Korinek S, An KN (1992) Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 280:186–197PubMedGoogle Scholar
  41. 41.
    Liew VS, Cooper IC, Ferreira LM et al (2003) The effect of metallic radial head arthroplasty on radiocapitellar joint contact area. Clin Biomech 18:115–118CrossRefGoogle Scholar
  42. 42.
    Schneeberger A, Sadowski MM, Jacob HAC (2004) Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 86:975–982PubMedGoogle Scholar
  43. 43.
    Dowdy PA, Bain GI, King GJ, Patterson SD (1995) The midline posterior elbow incision. An anatomical appraisal. J Bone Joint Surg Br 77:696–699PubMedGoogle Scholar
  44. 44.
    Van Glabbeek F, Van Rift R, Baumfeld J et al (2005) Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral ligament deficient elbow. J Bone Joint Surg Am 86:2629–2635Google Scholar
  45. 45.
    Birkedal JP, Deal DN, Ruch DS (2004) Loss of flexion after radial head replacement. J Shoulder and Elbow Surg 13:208–213CrossRefGoogle Scholar
  46. 46.
    Armstrong AD, Dunning CE, Faber KJ et al (2000) Rehabilitation of the medial collateral ligament-deficient elbow: an in vitro biomechanical study. J Hand Surg Am 25:1051–1057PubMedGoogle Scholar
  47. 47.
    Dunning CE, Zarzour ZD, Patterson SD et al (2001) Muscle forces and pronation stabilize the lateral ligament deficient elbow. Clin Orthop Relat Res 388:118–124PubMedCrossRefGoogle Scholar
  48. 48.
    Pugh DM, Wild LM, Schemitsch EH et al (2004) Standard surgical protocol to treat elbow dislocation with radial head and coronoid fractures. J Bone Joint Surg Am 86:1122–1130PubMedGoogle Scholar
  49. 49.
    McKee MD, Pugh DM, Wild LM et al (2005) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique. J Bone Joint Surg Am 87:22–32PubMedCrossRefGoogle Scholar
  50. 50.
    Hildebrand KA, Patterson SD, King GJ (1999) Acute elbow dislocations: simple and complex. Orthop Clin North Am 30:63–79PubMedCrossRefGoogle Scholar
  51. 51.
    Faber KJ, MacDermid JC, King GJW (2004) Modular metal radial head arthroplasty is an effective treatment for comminuted radial head fractures. Ninth Conference of the International Societies for Surgery of the Hand, Budapest Hungary (unpublished)Google Scholar
  52. 52.
    Parisien R, Doornberg J, Ring D (2005) Fracture-dislocations of the elbow: Replacement of the fractured radial head with a modular prosthesis. American Shoulder and Elbow Surgeons Annual Meeting, Washington DC (unpublished)Google Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Graham J. W. King
    • 1
  1. 1.Hand and Upper Limb Centre Division of Orthopaedic SurgeryUniversity of Western OntarioLondonCanada

Personalised recommendations