Radial Head Replacement

Chapter 8 Radial Head Replacement

Aviva Wolff, OTR/L, CHT

Elbow Stability

In the normal elbow, stability is provided by the bony anatomy, ligaments, and muscle forces surrounding the joint. The joint surfaces are highly congruent, thus contributing to the overall stability. The biceps and brachialis create a posterior force vector at the elbow, which is counteracted by the coronoid and radial head creating a joint reaction force at the elbow. Stability is further provided by the medial and lateral ligament complexes and the anterior capsule. Historically, much attention has been devoted to the role of the medial collateral ligament, but in recent years, descriptions of the anatomy of the lateral ligament complex have been discussed, expanded, and studied. Sojberg et al. have further studied the role of the lateral ligament complex in elbow stability. The findings of these investigators indicate that the lateral ligament complex, specifically the lateral ulnar collateral ligament, is a major stabilizer of the elbow joint. Elbow instability results when these structures are injured or disrupted.

Elbow Instability

Elbow instability results from a dislocation of the ulnohumeral joint and injury to the varus and valgus stabilizers of the elbow and the radial head. This injury often results from a forceful fall on an outstretched hand. The impact drives the head of the radius into the capitellum of the humerus, which may result in radial head and coronoid process fracture, medial collateral, posterolateral, and/or lateral collateral ligament disruption. When all of the previous structures are injured, the condition is described as the “terrible triad.”

Surgical/Medical Management

• The surgical treatment of complex unstable elbow injuries may include titanium radial head replacement, open reduction internal fixation to the radial head, primary repair of the posterolateral ligament, and open reduction internal fixation to the ulnohumeral joint.

• Nonsurgical treatment in the form of immobilization may be appropriate in less complex injuries.

• Radial head excision vs radial head replacement has long been debated among surgeons.

1 Radial head replacements have evolved over the years to include a metallic head, silicone head, allograft head, and most recently the titanium head replacement.

2 The titanium head replacement has been used effectively in the treatment of complex radial head fractures and fracture dislocations.

• The annular ligament is repaired surgically to reinforce lateral stability of the elbow.

Postoperative Phase I: Inflammation/Protection (Weeks 0 to 3)

PRECAUTIONS

• Maintain the shoulder position in neutral to external rotation and the forearm in pronation to avoid stress to the lateral elbow when the patient is not in the splint or performing the specific exercises described below

Tags: Handbook of Postsurgical Rehabilitation Guidelines

Jun 22, 2016 | Posted by admin in PHYSICAL MEDICINE & REHABILITATION | Comments Off

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