Radius, extraarticular, multifragmentary

 

 

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

 

 

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)

 

 

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