Patient of 64 Year old, with Olecranon fracture, Elbow dislocation, and radial head fracture cephalad displaced about 2 cm.
Dear Carlos,
I prefer to preserve radial head, because this is very important for postoperative elbow stability.
Dear Carlos,
Usually I try to reduced and fixed. Sometimes we consider the age and his job, it is not effect his job and old age, resect the radial head.
Dear Winn, I agree for excision of radial head in irreversible damage as a necessary surgery, but this may have e consequences in elbow stability.
I would prefer fixing all fractures including radial head. If very comminuted then also replacing it would be better option than simple excision.
Dear Friends
I think the important question is, if there is an Essex-Lopresti kind of injury behind it or not. If so, one must leave the radial head in or replace. If not, one may excise the radial head.
See: https://www.vumedi.com/video/pathomechanic-radial-head-fracture-classification/
for more explanation.
https://www.vumedi.com/video/pathomechanic-radial-head-fracture-classification/
In this complex injury I would sacrifice the radial head in order to get a better ROM postoperatively. In a 64-year- patient the resection is justified.
I would prefer mantain readial head. Is a primary stabilizer of the elbow, you can fix initially outside the elbow and then insert it into the elbow and fix it to the diaphisis with minimal risk of necrosis and it is a prophilactic treatmnt in the case of a damage of the interosseous membrane. I have not had problems with ROM movment of the elbow because the radial head normally.
This is a communited fracture.My experience with the postoperative ROM is different from the one shared above. Usually, in similar cases resection of the radial head was necessary at a second stage.
I always try to preserve radial head
in comminuted fxs I prefer to replace it with a prosthesis providing stability to the elbow
Keep the radial head as it is stabilizing the joint and assisting to the ligamentous healing. Even if the head is fractured at the neck junction and occasionally in more than two pieces, something that the majority will replace, there are surgeons who repair and use the head as spacer and in case of post-operative limitations, (in the long run and after the union of the ulnar fracture) they go back to remove it as elective procedure. These are accepting even fibrous union. Such research is presented in German literature.
I agree with the two last answers. Mantaining the radial head we recover stability of the elbow and the forearm. Otherwise if you don´t have enough experience, replace the radial head is not a simple surgery and mid term problems are common, having to remove it. I try to mantain the radial head and if there are problems and I am sure that there are no problems in the interosseous membrane of the forearm I simply remove it, as I told in my last answer.
In the case of a multi fragmentous fracture with a 64-old man I would proceed in solving the problem in one stage.
I will reduce the Dislocation and fix the ulna fr. and replace the radial head. Replacing the radial head is not a big undertaking , takes less time than fixing with a miniplate
I agree with George that radial head is important in stabilizing the joint and assisting to the ligamentous healing.
Retaining the radial head if there is no soft tissue attachment, will lead to avascular necrosis in few months time causing elbow pain mainly in rotation. Titanium radial head implant allows early mobilisation and I have few cases with out any problem
I agree about avascular necrosis. We must not forget that initial treatment till some years ago it was the silastic implant which we were removing some months later. The only thing we wanted was scar tissue and healing of the soft tissues in such position which was not permitting radial proximal migration. I agree that the new implants are much better than the one mentioned. Also the use of the original radial head as spacer is something that can be used in the absence of implants and there is literature in Germany which supporting the use in such conditions.