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Authors of section

Authors

Peter Kloen, David Ring

Executive Editors

Peter Trafton, Michael Baumgaertner

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Radius, extraarticular, multifragmentary

 
 
 
 
 

Fragmented metaphyseal diaphyseal fracture of the radial neck are uncommon and usually associated with an elbow fracture-dislocation.

Fragmented metaphyseal diaphyseal fracture of the radial neck are uncommon and usually associated with an elbow fracture-dislocation.

Nonoperative

Main indications

 
 
Well aligned elbow and likely to remain so

Note: Nonoperative treatment is generally only indicated if functional forearm rotation can be demonstrated with or without anesthetic injection.

Contraindications

  • Elbow subluxation or dislocation
  • Deformity likely to restrict forearm rotation
  • Infirm or dependent person
  • Polytrauma

Advantages

  • Avoids surgical risks of neurovascular injury
  • Fragmented radial neck fractures extending to the bicipital tuberosity are difficult to stabilize adequately

Disadvantages

  • Risk of elbow subluxation, elbow stiffness, and hindrance of forearm rotation
Well aligned elbow and likely to remain so

Note: Nonoperative treatment is generally only indicated if functional forearm rotation can be demonstrated with or without anesthetic injection.

Contraindications

  • Elbow subluxation or dislocation
  • Deformity likely to restrict forearm rotation
  • Infirm or dependent person
  • Polytrauma

Advantages

  • Avoids surgical risks of neurovascular injury
  • Fragmented radial neck fractures extending to the bicipital tuberosity are difficult to stabilize adequately

Disadvantages

  • Risk of elbow subluxation, elbow stiffness, and hindrance of forearm rotation

Radial head arthroplasty

Main indications

 
 
Irreparable radial head and neck

Further indications

  • In setting of fracture dislocations with instability or residual subluxation

Advantages

  • Allows for early motion

Disadvantages

  • Early loosening of the prosthesis
  • Risk of elbow stiffness (prosthesis too large)
  • Risk of unstable elbow (prosthesis too small)
Irreparable radial head and neck

Further indications

  • In setting of fracture dislocations with instability or residual subluxation

Advantages

  • Allows for early motion

Disadvantages

  • Early loosening of the prosthesis
  • Risk of elbow stiffness (prosthesis too large)
  • Risk of unstable elbow (prosthesis too small)

Bridge plate

Main indications

 
 
Displaced or unstable fracture when stable fixation is possible

Further indications

  • Fragmented fracture associated with elbow dislocation
  • Restriction of forearm rotation

Contraindications

  • No associated ligament injury (consider nonoperative treatment or resection of radial head)

Advantages

  • Stabilizes elbow and forearm
  • Retains native radial head

Disadvantages

  • Risk of radial nerve injury and implant prominence and restriction of forearm rotation
  • Technically demanding
Displaced or unstable fracture when stable fixation is possible

Further indications

  • Fragmented fracture associated with elbow dislocation
  • Restriction of forearm rotation

Contraindications

  • No associated ligament injury (consider nonoperative treatment or resection of radial head)

Advantages

  • Stabilizes elbow and forearm
  • Retains native radial head

Disadvantages

  • Risk of radial nerve injury and implant prominence and restriction of forearm rotation
  • Technically demanding