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Is a Silastic Radial Head Still a Reasonable Option?

  • Symposium: Controversies in Orthopaedics
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of “overstuffing,” cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial.

Questions/purposes

We asked whether intact or reconstructed primary elbow stabilizers permit use of silastic radial head implants without fragmentation, failure, and silicone synovitis.

Methods

We retrospectively reviewed 23 patients with unreconstructable radial head fractures who were treated with silastic radial head arthroplasty and concomitant repair and/or reconstruction of the medial ulnar collateral ligament and/or lateral ulnar collateral ligament. Analysis included range of motion, pain, stability, and radiographic assessments; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; and Mayo Elbow Performance Score (MEPS). The minimum followup was 16 months (average, 69.6 months; range, 16-165 months).

Results

At last followup, the mean elbow flexion was 145°, extension 11°, supination 80°, and pronation 83°. The mean MEPS score was 88.9. The mean DASH score was 11.8. There were eight reoperations, none resulting from failure of the radial head implants.

Conclusions

These results demonstrate silastic radial heads can be used with low complication rates and without evidence of synovitis when concomitant elbow ligament repair or reconstruction is performed.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Jason Baynes, MD, for his help in preparation of the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY, 10029, USA

    Yariv Maghen MD, Andrew J. Leo MD, Jennifer W. Hsu MD & Michael R. Hausman MD

Authors
  1. Yariv Maghen MD
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  2. Andrew J. Leo MD
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  3. Jennifer W. Hsu MD
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  4. Michael R. Hausman MD
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Correspondence to Michael R. Hausman MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Maghen, Y., Leo, A.J., Hsu, J.W. et al. Is a Silastic Radial Head Still a Reasonable Option?. Clin Orthop Relat Res 469, 1061–1070 (2011). https://doi.org/10.1007/s11999-010-1672-2

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  • DOI: https://doi.org/10.1007/s11999-010-1672-2

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