Authors of section

Editors

Peter Kloen, David Ring

Executive Editors

Peter Trafton, Michael Baumgaertner

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Radial head excision

1. Introduction

In unreconstructable radial head fractures, the excision is indicated:

  • in isolated radial head fracture
  • in low energy fracture
  • in radial head fracture without associated fracture or ligament injury

Radial head excision can produce instability of elbow or forearm (Essex-Lopresti lesion). Thus, it is contraindicated when the elbow joint is unstable (eg, coronoid fracture and / or collateral ligament rupture), or when the interosseous membrane and DRUJ have been injured.

2. Positioning and approach

Positioning

This procedure is normally performed with the patient in a supine position for lateral access.

radial head arthroplasty

Approach

For this procedure a lateral approach is normally used.

radial head arthroplasty

3. Resection of the radial head

Remove radial head fragments

Carefully remove all radial head fragments without further damage to the annular ligament.

Pearl: Reconstruct the radial head on a side-table to make sure that all fragments have been removed from the joint.

Radial head excision

Smoothing the radial neck edges

Smoothen the radial neck edges with the help of a small rongeur.

Do not unnecessarily further resect the neck.

Radial head excision

4. Final intraoperative assessment

If the annular ligament is ruptured, repair it with non-absorbable sutures. Check elbow range of motion in flexion, extension, pronation and supination. Check elbow stability.

Intraoperative C-arm evaluation is advisable to look for remaining fragments and alignment (as shown in the X-ray).

Also check the wrist with a C-arm and compare to the contralateral side to rule out radial shortening. If this is present it should be corrected with a radial head prosthesis.

Radial head excision