SURGICAL TREATMENT OF RADIAL HEAD FRACTURE

For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.

The Department of Orthopedic Surgery of Centrokinetic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

The radial head fracture occurs by direct axial load, due to the stress between the radial head and the capitulum, by the deviation of the elbow in the valgus (an obtuse open external angle appears between the arm and forearm) or in an elbow dislocation.

It most often occurs as a result of trauma by falling with the hand and elbow in extension. Isolated radial head fractures are easy to treat. But the key to success in treating radial head fractures is identifying and treating the associated conditions. This principle is very important if the fracture is displaced or if it involves the entire radial head. In the case of a complex radial head fracture, the associated capitulum fracture or rupture of the medial collateral ligament of the elbow must be investigated and diagnosed, so we consider it mandatory to investigate the elbow by MRI before surgery.

Indication of surgical treatment

Depending on the type of fracture, the degree of comminution, and the degree of displacement of the fragments, currently simple fractures with minimal displacement, which block the pronation-supination movement, comminutive fractures, and displacement fractures, have an absolute indication for surgical treatment.

The factors that influence the surgical treatment, the chosen technique, and the operative moment, are:

• Degree of fracture comminution
  A number greater than 3 fragments have no indication of reconstruction and fixing with the plate and individual screws or bolts unless they are large enough to be firmly fixed.
• the degree of osteoporosis, which sometimes does not allow the fracture to be fixed and causes the doctor to resect the radial head
• fragment size: if they are very small they cannot be reattached and fixed firmly, so the resection of the radial head is indicated
• the degree of impact and deviation of the radial head, which sometimes does not allow anatomical restoration and firm fixation of the fragments.

Surgical treatment options

• Radial head resection: without replacing it with a prosthesis, it is still a very good method of treatment, especially in elderly patients, but also in case of an elbow fracture-dislocation, without a coronoid process fracture.
• Resection of the radial head with its replacement with a prosthesis. Stability-wise, the replacement of the radial head with a prosthesis offers good functional results, initially, but in time it causes repeated arthritis, synovitis, and finally, osteoarthritis.
• Partial radial head resection

• Rezectia partiala de cap radial

Currently, this surgical option has been abandoned, due to the degree of postoperative instability, the lack of anatomical shape of the radial head that will lead over time (several years) to osteoarthritis of the elbow, limiting joint movements, and severe pain.

• Fracture reduction and fixation with plate and screws or individual screws: it is indicated whenever there is a chance of anatomical restoration of the radial head and stable, firm fixation. It is the most common surgical treatment option.
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1. Kocher: between the anconeus muscle and the ulnar extensor muscle of the carpus. It is the most commonly used approach, is posterior, relatively simple and offers a good intraoperative approach and visibility. It has a low risk of damaging the posterior interosseous nerve. The external collateral ligament of the choir must be protected.
2. Kaplan: between the short radial extensor muscle of the carpus and the common extensor muscle of the fingers.