Radial head fractures, which occur most commonly from a fall on an outstretched hand and occasionally from a blow to the lateral (outside) portion of the elbow.

In some cases the displaced fracture is too comminuted (fragmented) to be successfully treated with open repair and internal fixation (ORIF), which is an effective treatment for many types of elbow fractures.

But, in such fracture cases involving greater than 1/3 of the radial head and multiple displaced fragments, a radial head arthroplasty may be indicated.
Indications for surgical management of radial head fractures are well defined in the literature: fragment size, number, degree of displacement, and bone quality are considerations for best treatment.

Associated injuries and a block to motion (a block to rotation of the forearm or a block to flexion and extension of the elbow due to a displaced fragment inhibiting rotation) are also important factors to consider.

Radial head fracture fixation, fragment excision and early or delayed radial head excision as well as replacement all play a role in the treatment of these types of injuries.

Patients known to have or likely to have an associated ligamentous injury of the elbow or forearm should undergo a radial head fracture fixation or arthroplasty, as radial head excision is not recommended.(1)

When it is determined that a radial head arthroplasty or joint replacement is indicated, Dr. Jafarnia chooses a smooth stem radial head implant such as the Avenger Radial Head Prosthesis System.

The smooth stem radial head implants are proving to produce better long-term results. The simplicity and modularity (with multiple head and stem sizes) of the Avenger Radial Head prosthesis system reduces surgical time and enables restoration of the appropriate height of the radius – aiding in elbow stability.

Indications for Radial Head Arthroplasty include:

• Irreparable radial head fracture – with or without ligament instability
• Comminuted radial head fracture with associated failure of the interosseous membrane; the Essex-Lopresti lesion
• Post-traumatic or primary osteoarthritis involving the radiocapitellar or proximal radioulnar joint
• Rheumatoid arthritis involving the radiocapitellar joint or proximal radioulnar joints – not common
• Revision of failed radial head implant

References
1. King GJ, Management of Radial Head Fractures with Implant Arthroplasty. J Am Soc Surg Hand. 2004. Feb 4(1):11-26.

Read more about the Avenger Radial Head Prosthesis System developed by In2Bones Global Inc.