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Treatment of radial head and neck fractures: in favor of anatomical reconstruction

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Abstract

Radial head fractures represent the most common elbow fractures. Undisplaced fractures usually occur in isolation and can be treated nonsurgically. Displaced fractures should be treated surgically. Simple two-part fractures can easily be handled by osteosynthesis, but comminuted fractures pose a major problem for reconstruction. As the radial head is an important stabilizer of the elbow joint—especially in the context of concomitant ligamentous injuries—its resection may lead to pain, limited range of motion, and instability. Therefore, radial head resection is not recommended for the acute situation and open reduction internal fixation (ORIF) or prosthetic replacement should be aimed for. Complications such as secondary loss of fixation, radial head necrosis, and nonunion due to insufficient stability of the osteosynthesis have often been described. Therefore, prosthetic replacement is recommended if stable reconstruction is impossible. With the development of new locking plates especially designed for the maintenance of radial head fractures, the indications for osteosynthesis may be extended. As radial head fractures are complicated by a high percentage of ligamentous injuries and concomitant elbow fractures such as the coronoid, capitellum, and proximal ulna, these additional injuries have to be taken into account. The current treatment concepts are discussed within this paper.

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References

  1. Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res. 1991;265:187–95.

    PubMed  Google Scholar 

  2. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am. 2004;86-A(8):1730–9.

    PubMed  Google Scholar 

  3. Johnson JA, Beingessner DM, Gordon KD, Dunning CE, Stacpoole RA, King GJ. Kinematics and stability of the fractured and implant-reconstructed radial head. J Shoulder Elbow Surg. 2005;14(1 Suppl S):195S–201S. doi:10.1016/j.jse.2004.09.034.

    Article  PubMed  Google Scholar 

  4. King GJ, Zarzour ZD, Rath DA, Dunning CE, Patterson SD, Johnson JA. Metallic radial head arthroplasty improves valgus stability of the elbow. Clin Orthop Relat Res. 1999;368:114–25.

    Article  PubMed  Google Scholar 

  5. Pomianowski S, Morrey BF, Neale PG, Park MJ, O’Driscoll SW, An KN. Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am. 2001;83-A(12):1829–34.

    PubMed  CAS  Google Scholar 

  6. Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am. 2004;86-A(5):975–82.

    PubMed  Google Scholar 

  7. Morrey BF, An KN, Stormont TJ. Force transmission through the radial head. J Bone Joint Surg Am. 1988;70(2):250–6.

    PubMed  CAS  Google Scholar 

  8. Davidson PA, Moseley JB Jr, Tullos HS. Radial head fracture. A potentially complex injury. Clin Orthop Relat Res. 1993;297:224–30.

    PubMed  Google Scholar 

  9. Hausmann JT, Vekszler G, Breitenseher M, Braunsteiner T, Vécsei V, Gäbler C. Mason type-I radial head fractures and interosseous membrane lesions—a prospective study. J Trauma. 2009;66(2):457–61. doi:10.1097/TA.0b013e31817fdedd.

    Article  PubMed  Google Scholar 

  10. Itamura J, Roidis N, Mirzayan R, Vaishnav S, Learch T, Shean C. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg. 2005;14(4):421–4. doi:10.1016/j.jse.2004.11.003.

    Article  PubMed  Google Scholar 

  11. Kaas L, van Riet RP, Turkenburg JL, Vroemen JP, van Dijk CN, Eygendaal D. Magnetic resonance imaging in radial head fractures: most associated injuries are not clinically relevant. J Shoulder Elbow Surg. 2011;20(8):1282–8. doi:10.1016/j.jse.2011.06.011.

    Article  PubMed  Google Scholar 

  12. Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J. 1962;31:51–6.

    PubMed  CAS  Google Scholar 

  13. Hotchkiss RN. Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg. 1997;5(1):1–10.

    PubMed  Google Scholar 

  14. Ring D. Displaced, unstable fractures of the radial head: fixation vs. replacement—what is the evidence? Injury. 2008;39(12):1329–37. doi:10.1016/j.injury.2008.04.011.

    Article  PubMed  Google Scholar 

  15. Akesson T, Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Karlsson MK. Primary nonoperative treatment of moderately displaced two-part fractures of the radial head. J Bone Joint Surg Am. 2006;88(9):1909–14. doi:10.2106/JBJS.E.01052.

    Article  PubMed  Google Scholar 

  16. Liow RY, Cregan A, Nanda R, Montgomery RJ. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury. 2002;33(9):801–6. pii:S002013830200164X.

    Article  PubMed  CAS  Google Scholar 

  17. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg. 1954;42(172):123–32.

    Article  PubMed  CAS  Google Scholar 

  18. Herbertsson P, Josefsson PO, Hasserius R, Karlsson C, Besjakov J, Karlsson MK. Displaced Mason type I fractures of the radial head and neck in adults: a fifteen- to thirty-three-year follow-up study. J Shoulder Elbow Surg. 2005;14(1):73–7. doi:10.1016/j.jse.2004.07.001.

    Article  PubMed  Google Scholar 

  19. Burkhart KJ, Fanke S, Müller LP, Hollinger B. Die nicht dislozierte Radiuskopffraktur—Eine harmlose Verletzung? DVSE 2012; Berlin, Germany. Abstract Band DVSE 2012. p. 124.

  20. Esser RD, Davis S, Taavao T. Fractures of the radial head treated by internal fixation: late results in 26 cases. J Orthop Trauma. 1995;9(4):318–23.

    Article  PubMed  CAS  Google Scholar 

  21. King GJ, Evans DC, Kellam JF. Open reduction and internal fixation of radial head fractures. J Orthop Trauma. 1991;5(1):21–8.

    Article  PubMed  CAS  Google Scholar 

  22. Lindenhovius AL, Felsch Q, Ring D, Kloen P. The long-term outcome of open reduction and internal fixation of stable displaced isolated partial articular fractures of the radial head. J Trauma. 2009;67(1):143–6. doi:10.1097/TA.0b013e31818234d6.

    Article  PubMed  Google Scholar 

  23. Ring D. Open reduction and internal fixation of fractures of the radial head. Hand Clin. 2004;20(4):415–27. doi:10.1016/j.hcl.2004.06.001.

    Article  PubMed  Google Scholar 

  24. Khalfayan EE, Culp RW, Alexander AH. Mason type II radial head fractures: operative versus nonoperative treatment. J Orthop Trauma. 1992;6(3):283–9.

    Article  PubMed  CAS  Google Scholar 

  25. Burkhart KJ, Nowak TE, Appelmann P, Sternstein W, Rommens PM, Mueller LP. Screw fixation of radial head fractures: compression screw versus lag screw—a biomechanical comparison. Injury. 2010;41(10):1015–9. doi:10.1016/j.injury.2010.03.001.

    Article  PubMed  Google Scholar 

  26. Koslowsky TC, Mader K, Dargel J, Koebke J, Hellmich M, Pennig D. Reconstruction of a Mason type-III fracture of the radial head using four different fixation techniques. An experimental study. J Bone Joint Surg Br. 2007;89(11):1545–50. doi:10.1302/0301-620X.89B11.19433.

    Article  PubMed  CAS  Google Scholar 

  27. Burkhart KJ, Mueller LP, Krezdorn D, Appelmann P, Prommersberger KJ, Sternstein W, et al. Stability of radial head and neck fractures: a biomechanical study of six fixation constructs with consideration of three locking plates. J Hand Surg Am. 2007;32(10):1569–75. doi:10.1016/j.jhsa.2007.08.023.

    Article  PubMed  Google Scholar 

  28. Caputo AE, Mazzocca AD, Santoro VM. The nonarticulating portion of the radial head: anatomic and clinical correlations for internal fixation. J Hand Surg Am. 1998;23(6):1082–90. doi:10.1016/S0363-5023(98)80020-8.

    Article  PubMed  CAS  Google Scholar 

  29. Smith GR, Hotchkiss RN. Radial head and neck fractures: anatomic guidelines for proper placement of internal fixation. J Shoulder Elbow Surg. 1996;5(2 Pt 1):113–7.

    Article  Google Scholar 

  30. Soyer AD, Nowotarski PJ, Kelso TB, Mighell MA. Optimal position for plate fixation of complex fractures of the proximal radius: a cadaver study. J Orthop Trauma. 1998;12(4):291–3.

    Article  PubMed  CAS  Google Scholar 

  31. Kaas L, Turkenburg JL, van Riet RP, Vroemen JP, Eygendaal D. Magnetic resonance imaging findings in 46 elbows with a radial head fracture. Acta Orthop. 2010;81(3):373–6. doi:10.3109/17453674.2010.483988.

    Article  PubMed  Google Scholar 

  32. Mikíc ZD, Vukadinovíc SM. Late results in fractures of the radial head treated by excision. Clin Orthop Relat Res. 1983;181:220–8.

    PubMed  Google Scholar 

  33. Pike JM, Athwal GS, Faber KJ, King GJ. Radial head fractures—an update. J Hand Surg Am. 2009;34(3):557–65. doi:10.1016/j.jhsa.2008.12.024.

    Article  PubMed  Google Scholar 

  34. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002;84-A(10):1811–5.

    PubMed  Google Scholar 

  35. King GJ, Patterson SD. Metallic radial head arthroplasty. Tech Hand Up Extrem Surg. 2001;5(4):196–203. pii:00130911-200112000-00003.

    Article  PubMed  CAS  Google Scholar 

  36. Yian E, Steens W, Lingenfelter E, Schneeberger AG. Malpositioning of radial head prostheses: an in vitro study. J Shoulder Elbow Surg. 2008;17(4):663–70. doi:10.1016/j.jse.2007.12.008.

    Article  PubMed  Google Scholar 

  37. Burkhart KJ, Mattyasovszky SG, Runkel M, Schwarz C, Küchle R, Hessmann MH, et al. Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg. 2010;19(7):965–72. doi:10.1016/j.jse.2010.05.022.

    Article  PubMed  Google Scholar 

  38. Dotzis A, Cochu G, Mabit C, Charissoux JL, Arnaud JP. Comminuted fractures of the radial head treated by the Judet floating radial head prosthesis. J Bone Joint Surg Br. 2006;88(6):760–4. doi:10.1302/0301-620X.88B6.17415.

    Article  PubMed  CAS  Google Scholar 

  39. Frosch KH, Knopp W, Dresing K, Langer C, Stürmer KM. A bipolar radial head prosthesis after comminuted radial head fractures: indications, treatment and outcome after 5 years. Unfallchirurg. 2003;106(5):367–73. doi:10.1007/s00113-003-0573-1.

    Article  PubMed  Google Scholar 

  40. Grewal R, MacDermid JC, Faber KJ, Drosdowech DS, King GJ. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J Bone Joint Surg Am. 2006;88(10):2192–200. doi:10.2106/JBJS.E.00962.

    Article  PubMed  Google Scholar 

  41. Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ. Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am. 2001;83-A(8):1201–11.

    PubMed  CAS  Google Scholar 

  42. Popovic N, Gillet P, Rodriguez A, Lemaire R. Fracture of the radial head with associated elbow dislocation: results of treatment using a floating radial head prosthesis. J Orthop Trauma. 2000;14(3):171–7.

    Article  PubMed  CAS  Google Scholar 

  43. Shore BJ, Mozzon JB, MacDermid JC, Faber KJ, King GJ. Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty. J Bone Joint Surg Am. 2008;90(2):271–80. doi:10.2106/JBJS.F.01535.

    Article  PubMed  Google Scholar 

  44. Wick M, Lies A, Müller EJ, Hahn MP, Muhr G. Prostheses of the head of the radius. What outcome can be expected? Unfallchirurg. 1998;101(11):817–21.

    Article  PubMed  CAS  Google Scholar 

  45. Van Glabbeek F, Van Riet RP, Baumfeld JA, Neale PG, O’Driscoll SW, Morrey BF, et al. Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg Am. 2004;86-A(12):2629–35. pii:86/12/2629.

    PubMed  Google Scholar 

  46. Van Glabbeek F, van Riet RP, Baumfeld JA, Neale PG, O’Driscoll SW, Morrey BF, et al. The kinematic importance of radial neck length in radial head replacement. Med Eng Phys. 2005;27(4):336–42. doi:10.1016/j.medengphy.2004.04.011.

    Article  PubMed  Google Scholar 

  47. van Riet RP, Van Glabbeek F, Baumfeld JA, Neale PG, Morrey BF, O’Driscoll SW, et al. The effect of the orientation of the noncircular radial head on elbow kinematics. Clin Biomech (Bristol, Avon). 2004;19(6):595–9. doi:10.1016/j.clinbiomech.2004.03.002.

    Article  Google Scholar 

  48. Doornberg JN, Linzel DS, Zurakowski D, Ring D. Reference points for radial head prosthesis size. J Hand Surg Am. 2006;31(1):53–7. doi:10.1016/j.jhsa.2005.06.012.

    Article  PubMed  Google Scholar 

  49. Frank SG, Grewal R, Johnson J, Faber KJ, King GJ, Athwal GS. Determination of correct implant size in radial head arthroplasty to avoid overlengthening. J Bone Joint Surg Am. 2009;91(7):1738–46. doi:10.2106/JBJS.H.01161.

    Article  PubMed  Google Scholar 

  50. Athwal GS, Rouleau DM, MacDermid JC, King GJ. Contralateral elbow radiographs can reliably diagnose radial head implant overlengthening. J Bone Joint Surg Am. 2011;93(14):1339–46. doi:10.2106/JBJS.J.01244.

    Article  PubMed  Google Scholar 

  51. Beredjiklian PK, Nalbantoglu U, Potter HG, Hotchkiss RN. Prosthetic radial head components and proximal radial morphology: a mismatch. J Shoulder Elbow Surg. 1999;8(5):471–5.

    Article  PubMed  CAS  Google Scholar 

  52. King GJ, Zarzour ZD, Patterson SD, Johnson JA. An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplasty. 2001;16(1):112–6. doi:10.1054/arth.2001.16499.

    Article  PubMed  CAS  Google Scholar 

  53. Koslowsky TC, Germund I, Beyer F, Mader K, Krieglstein CF, Koebke J. Morphometric parameters of the radial head: an anatomical study. Surg Radiol Anat. 2007;29(3):225–30. doi:10.1007/s00276-007-0197-1.

    Article  PubMed  CAS  Google Scholar 

  54. Kuhn S, Burkhart KJ, Schneider J, Muelbert BK, Hartmann F, Mueller LP, et al. The anatomy of the proximal radius: implications on fracture implant design. J Shoulder Elbow Surg. 2012;21(9):1247–54. doi:10.1016/j.jse.2011.11.008.

    Article  PubMed  Google Scholar 

  55. Popovic N, Djekic J, Lemaire R, Gillet P. A comparative study between proximal radial morphology and the floating radial head prosthesis. J Shoulder Elbow Surg. 2005;14(4):433–40. doi:10.1016/j.jse.2004.10.012.

    Article  PubMed  Google Scholar 

  56. Businger A, Ruedi TP, Sommer C. On-table reconstruction of comminuted fractures of the radial head. Injury. 2010;41(6):583–8. doi:10.1016/j.injury.2009.10.026.

    Article  PubMed  Google Scholar 

  57. Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg Am. 2005;87(1):76–84. doi:10.2106/JBJS.C.01323.

    Article  PubMed  Google Scholar 

  58. Ikeda M, Yamashina Y, Kamimoto M, Oka Y. Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates. J Bone Joint Surg Br. 2003;85(7):1040–4.

    Article  PubMed  CAS  Google Scholar 

  59. Koslowsky TC, Mader K, Gausepohl T, Pennig D. Reconstruction of Mason type-III and type-IV radial head fractures with a new fixation device: 23 patients followed 1–4 years. Acta Orthop. 2007;78(1):151–6. doi:10.1080/17453670610013565.

    Article  PubMed  Google Scholar 

  60. Nalbantoglu U, Kocaoglu B, Gereli A, Aktas S, Guven O. Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation. J Hand Surg Am. 2007;32(10):1560–8. doi:10.1016/j.jhsa.2007.09.016.

    Article  PubMed  Google Scholar 

  61. Burkhart KJ, Nowak TE, Kim YJ, Rommens PM, Müller LP. Anatomic fit of six different radial head plates: comparison of precontoured low-profile radial head plates. J Hand Surg Am. 2011;36(4):617–24. doi:10.1016/j.jhsa.2010.12.028.

    Article  PubMed  Google Scholar 

  62. Burkhart KJ, Gruszka D, Wegmann K, Jimenez-Frohn M, Dargel J, Rommens PM, et al. Ergebnisse nach winkelstabiler Plattenosteosynthese des Radiuskopfes. DVSE 2012; Berlin, Germany. Abstract band DVSE 2012. p. 130.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany

    K. J. Burkhart, K. Wegmann, J. Dargel, C. Ries & L. P. Mueller

  2. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Cologne, Germany

    K. J. Burkhart

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Correspondence to K. J. Burkhart.

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K. J. Burkhart and K. Wegmann contributed equally to this article.

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Burkhart, K.J., Wegmann, K., Dargel, J. et al. Treatment of radial head and neck fractures: in favor of anatomical reconstruction. Eur J Trauma Emerg Surg 38, 593–603 (2012). https://doi.org/10.1007/s00068-012-0222-x

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