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Radial head replacement best evidence

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Radial head replacement best evidence

  1. 1. Hitesh Gopalan Clinical Asst Professor. www.orthoevidence.com www.orthopaedicprinciples.com
  2. 2. Radial Head  Valgus stabiliser  Axial Stabiliser  60% of load transfer
  3. 3. Problems  Comminution  LUCL injury  MCL injury  Elbow Dislocation  Coronoid fracture  Essex Lopresti Injury(ALRUD)
  4. 4. Ligamentous Instability
  5. 5. Treatment Options  Conserve  Fixation  Excision  Partial excision  Replacement
  6. 6. Guidelines  Mason 1: Conservative  Mason 2: Fix
  7. 7.  Mason 3 and 4: Fix with ligamentous repair, Replace or Partially Excise?  Ligamentous Instability
  8. 8. When Replace  Mason type 3 fractures  Associated ligamentous injuries(ALRUD)  Complex injury(Terrible triad)
  9. 9. Replace Vs Fixation  Three or more fragments  Impaction  Significant metaphyseal bone loss
  10. 10. Radial Head Excision  Chronic ulnar wrist pain, Instability  Elbow stiffness, Proximal radial migration 2-3 mm  Loss of strength, Degenerative arthritis  Cubitus valgus, Heterotopic calcification  Myositis ossificans, Radial tunnel syndrome  Synostosis, Ulnar neuropathy Clin Orthop Relat Res. 1998; 353:40-52.
  11. 11. Radial Head Replacement  monoblock metal  press-fit and ingrowth stems,  cemented stems, bipolar , and ceramic  Floating Radial head prosthesis(Tornier, Fr)  Acrylic, silicone rubber, cobaltchromium Alloy, titanium  Osteochondral autografts(Han KJ 2012)
  12. 12. What’s the Evidence  Level 4  Level 3  Level 2 No level 1 randomised trial that compares radial head replacement with fixation
  13. 13. Replacement –Level IV  Moro et al..  El Sallakh S (J Orthop Trauma 2012)  Shore et al(JBJS A-2008)  Excellent to Good Results in 80%  Less reports on complications like loosening, wear
  14. 14.      Level 3 Retrospective Case control design Complex Injuries Fixation (13)Vs Replacement(11) Outcomes: ASES , DASH scores  Better functional outcomes with Replacement
  15. 15. •Radial head replacement: 14 patients •Radial head repair: 8 cases •Level: IV •Outcome assessment: Broberg and Morrey scale •92. 9% satisfactory results in replacement group Vs 12.5 % satisfactory results in fixation group
  16. 16. Replacement: 22 patients Repair: 23 patients Outcomes: Broberg and Morrey System Analysis: Satisfactory outcome in 91% in replacement group Vs 65% in ORIF Level 2 Randomised Trial
  17. 17. Xiao Chen et al..Int Orthop 2011
  18. 18. Replacement  Accurate Sizing and length  Avoid overstuffing the joint  Damage to articular cartilage of capitellum
  19. 19. Level IV retrospective case series(n=32) MyoPC Prosthesis Outcomes: Broberg and Morrey, Mayo Elbow Performance Satisfactory Outcomes
  20. 20. Radial head Fractures  Undisplaced(Mason 1): Conservative with early mobilisation  Comminuted: Elderly- EXCISION
  21. 21. Radial Head  Mason 2: one or two fragments, dense bone: Fix  Mason 3-4: Replace
  22. 22. Thank You

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