Reconstruction Techniques for Fractures of the Proximal Ulna and Radial Head

2016 ◽  
pp. 59-86
Author(s):  
James M. McLean ◽  
George S. Athwal ◽  
Parham Daneshvar
Keyword(s):  
Radial Head ◽  
Proximal Ulna

scholarly journals Radial head fractures

2019 ◽  
Vol 12 (3) ◽  
pp. 212-223 ◽  
Author(s):  
RP van Riet ◽  
MPJ van den Bekerom ◽  
A Van Tongel ◽  
C Spross ◽  
R Barco ◽  
...  
Keyword(s):  
Radial Head ◽  
Long Term Results ◽  
Valgus Stress ◽  
Proximal Ulna ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Radial Head Replacement ◽  
Treatment Type ◽  
Radial Head Resection ◽  
Type 3

The shape and size of the radial head is highly variable but correlates to the contralateral side. The radial head is a secondary stabilizer to valgus stress and provides lateral stability. The modified Mason–Hotchkiss classification is the most commonly used and describes three types, depending on the number of fragments and their displacement. Type 1 fractures are typically treated conservatively. Surgical reduction and fixation are recommended for type 2 fractures, if there is a mechanical block to motion. This can be done arthroscopically or open. Controversy exists for two-part fractures with >2 mm and <5 mm displacement, without a mechanical bloc as good results have been published with conservative treatment. Type 3 fractures are often treated with radial head replacement. Although radial head resection is also an option as long-term results have been shown to be favourable. Radial head arthroplasty is recommended in type 3 fractures with ligamentous injury or proximal ulna fractures. Failure of primary radial head replacement may be due to several factors. Identification of the cause of failure is essential. Failed radial head arthroplasty can be treated by implant removal alone, interposition arthroplasty, revision radial head replacement either as a single stage or two-stage procedure.

scholarly journals Fractures of the proximal ulna: current concepts in surgical management

2019 ◽  
Vol 4 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Sebastian Siebenlist ◽  
Arne Buchholz ◽  
Karl F. Braun
Keyword(s):  
Radial Head ◽  
Injury Severity ◽  
Joint Stiffness ◽  
Coronoid Process ◽  
Collateral Ligament ◽  
Postoperative Rehabilitation ◽  
Proximal Ulna ◽  
Elbow Function ◽  
Fracture Types ◽  
Olecranon Fractures

Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e. coronoid process, radial head, collateral ligament complex). In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity. Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first). The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation. For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint. Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability. Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function. The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness. Cite this article: EFORT Open Rev 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.

scholarly journals Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children

2021 ◽  
Vol 27 (3) ◽  
pp. 319-321
Author(s):  
K. Li ◽  
◽  
S. Rong ◽  
C. Zheng ◽  
Y. Teng ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Radial Head ◽  
Fracture Reduction ◽  
Proximal Ulna ◽  
Compression Fractures ◽  
Fractures In Children ◽  
Ulnar Fracture

Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini–fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.

scholarly journals Surgical treatment of chronic anterior radial head dislocations in missed Monteggia lesions in children: A rationale for treatment and pearls and pitfalls of surgery

2019 ◽  
Vol 12 (6) ◽  
pp. 422-431
Author(s):  
LC Langenberg ◽  
ACH Beumer ◽  
B The ◽  
KLM Koenraadt ◽  
D Eygendaal
Keyword(s):  
Range Of Motion ◽  
Radial Head ◽  
Ligament Reconstruction ◽  
Annular Ligament ◽  
Proximal Ulna ◽  
Monteggia Lesion ◽  
Ulna Osteotomy ◽  
Annular Ligament Reconstruction ◽  
Monteggia Lesions ◽  
Missed Monteggia

Introduction The treatment of chronic radial head dislocations after Monteggia lesions in children can be challenging. This article provides a detailed description of the most frequently performed surgical technique: an ulna osteotomy followed by annular ligament reconstruction. Accordingly, we present the clinical and radiological results of 10 paediatric cases. Material and methods All paediatric patients that had a corrective osteotomy of the ulna for a missed Monteggia lesion between 2008 and 2014 were evaluated with standard radiographs and clinical examination. A literature search was performed to identify the relevant pearls and pitfalls of surgery. Primary outcome was range of motion. Results We included 10 patients, with a mean follow-up of 2.5 years. Postoperative range of motion generally improved 30.7°. Even in a patient with obvious deformity of the radial head, range of motion improved after surgery, without residual dislocation of the radial head. Conclusion Corrective proximal ulna osteotomy with rigid plate fixation and annular ligament reconstruction yields good results in patients with chronic radial head dislocation following a Monteggia lesion. Surgery should be considered regardless of patient age or time since trauma. Given substantial arguments in literature, we discourage surgery if a CT scan shows dome-shaped radial head dysmorphic features in work-up to surgery.

Intra-articular osteoid osteoma in the proximal ulna combined with radial head subluxation: a case report

2012 ◽  
Vol 21 (8) ◽  
pp. e1-e5 ◽  
Author(s):  
Ji Hyeung Kim ◽  
Hyuk Jin Lee ◽  
Goo Hyun Baek
Keyword(s):  
Case Report ◽  
Osteoid Osteoma ◽  
Radial Head ◽  
Proximal Ulna

Radial Head Subluxation After Malalignment of the Proximal Ulna

2014 ◽  
Vol 28 (8) ◽  
pp. 464-469 ◽  
Author(s):  
Emilie Sandman ◽  
Fanny Canet ◽  
Yvan Petit ◽  
George Y. Laflamme ◽  
George S. Athwal ◽  
...  
Keyword(s):  
Radial Head ◽  
Proximal Ulna

Reconstruction of the Interosseous Ligament of the Forearm Reduces Load on the Radial Head in Cadavers

2003 ◽  
Vol 28 (3) ◽  
pp. 267-270 ◽  
Author(s):  
MATTHEW M. TOMAINO ◽  
JAMIE PFAEFFLE ◽  
KATHRYNE STABILE ◽  
ZONG-MING LI
Keyword(s):  
Radial Head ◽  
Ligament Reconstruction ◽  
Load Transfer ◽  
Normal Load ◽  
Interosseous Ligament ◽  
Proximal Ulna ◽  
Radial Head Fractures ◽  
Proximal Migration ◽  
Force Transfer ◽  
Biomechanical Effect

Excision of the radial head after fracture may be complicated by longitudinal radio-ulnar instability (Essex-Lopresti lesion) if the forearm interosseous ligament has also been torn. In such cases proximal migration of the radius occurs, and ulnar impaction at the wrist and radiocapitellar contact at the elbow may impair function. Although metal radial head arthroplasties are now used for irreparable radial head fractures, the long-term clinical outcome may still be unsatisfactory because of excessive radiocapitellar load causing pain. Interosseous ligament reconstruction might improve outcome by restoring normal load transfer from the radius to ulna, but the biomechanical effect of reconstruction has not been reported. This study evaluated forearm load transfer following interosseous ligament reconstruction with an Achilles tendon allograft in a cadaveric model with the radial head intact. Interosseous ligament reconstruction reduced proximal radius loading by transferring force to the proximal ulna, but force transfer by the reconstruction was only half that by the intact ligament.

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