Intraoperative radiographic method of locating the radial head safe zone: the bicipital tuberosity view

A visible posterior fat pad on the lateral view of the elbow is a sign of occult intraarticular pathology. Early elbow ROM is needed to prevent stiffness. If you fixed the fracture, but not well enough to move the elbow, you did not fix it. The “safe zone” for placing hardware on the radial head lies in the interval between the radial styloid and Lister’s tubercle. Examine the wrist when examining all elbow injuries; a radial head fracture may be accompanied by a tear of the interosseous membrane and disruption of the distal radioulnar joint. The posterior interosseous nerve (controlling finger and wrist extension) can be damaged by a radial head injury or by the surgery performed to treat the fracture. Therefore, document functional status preoperatively. The severity of these injuries runs the gamut from minimally displaced fractures needing minimal treatment to those with major displacement or comminution, requiring surgical fixation, excision, or replacement.

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Is an extension of the safe zone possible without jeopardizing the proximal radioulnar joint when performing a radial head plate osteosynthesis?

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2015.03.010 ◽

2015 ◽

Vol 24 (10) ◽

pp. 1627-1634 ◽

Cited By ~ 14

Author(s):

Christian Ries ◽

Marcel Müller ◽

Kilian Wegmann ◽

Doreen B. Pfau ◽

Lars P. Müller ◽

...

Keyword(s):

Radial Head ◽

Plate Osteosynthesis ◽

Safe Zone ◽

Radioulnar Joint

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The bicipital tuberosity and distal radius are unreliable landmarks for radial head implant alignment

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2013.02.013 ◽

2013 ◽

Vol 22 (9) ◽

pp. 1242-1247 ◽

Cited By ~ 2

Author(s):

Ryan N. Katchky ◽

Graham J.W. King ◽

James A. Johnson ◽

George S. Athwal

Keyword(s):

Distal Radius ◽

Radial Head ◽

Implant Alignment ◽

Bicipital Tuberosity

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Ultrasonographic Measurement of Elbow Varus Laxity With a Sequential Injury Model of the Lateral Collateral Ligament–Capsular Complex

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211048941 ◽

2021 ◽

Vol 9 (11) ◽

pp. 232596712110489

Author(s):

Jae-Man Kwak ◽

Dani Rotman ◽

Jorge Rojas Lievano ◽

James S. Fitzsimmons ◽

Shawn W. O’Driscoll

Keyword(s):

Radial Head ◽

Tennis Elbow ◽

Lateral Collateral Ligament ◽

Elbow Flexion ◽

Safe Zone ◽

Ligament Injury ◽

Collateral Ligament ◽

Custom Made ◽

Varus Stress ◽

Extensor Carpi Radialis

Background: There is no consensus how to determine the varus laxity due to the LCL injury using the ultrasonography. There is a risk of lateral collateral ligament injury during or after arthroscopic extensor carpi radialis brevis release for tennis elbow. The equator of the radial head has been suggested as a landmark for the safe zone to not increase this risk; however, the safe zone from the intra-articular space has not been established. Hypothesis: Increased elbow varus laxity due to lateral collateral ligament–capsular complex (LCL-cc) injury could be assessed reliably via ultrasound. Study Design: Descriptive laboratory study. Methods: Eight cadaveric elbows were evaluated using a custom-made machine allowing passive elbow flexion under gravity varus stress. The radiocapitellar joint (RCJ) space was measured via ultrasound at 30° and 90° of flexion during 4 stages: intact elbow (stage 0), release of the anterior one-third of the LCL-cc (stage 1), release of the anterior two-thirds (stage 2), and release of the entire LCL-cc (stage 3). Two observers conducted the measurements separately, and the mean RCJ space in the 3 LCL-cc injury models (stages 1-3) at both flexion angles was compared with that of the intact elbow (stage 0). We also compared the measurements at 30° versus 90° of flexion. Results: At 30° of elbow flexion, the RCJ space increased 2 mm between stages 0 and 2 (95% confidence interval [CI], 1-3 mm; P < .01) and 4 mm between stages 0 and 3 (95% CI, 2-5 mm; P < .01). At 90° of elbow flexion, the RCJ space increased 1 mm between stages 0 and 2 (95% CI, 1-2 mm; P < .01) and 2 mm between stages 0 and 3 (95% CI, 2-3 mm; P < .01). Conclusion: Elbow varus laxity under gravity stress can be reliably assessed via ultrasound by measuring the RCJ space. Clinical Relevance: Because ultrasonographic measurement of the RCJ space can distinguish the increasing varus laxity seen with release of two-thirds or more of the LCL-cc, the anterior one-third of the LCL-cc, based on the diameter of the radial head, can be considered the safe zone in arthroscopic extensor carpi radialis brevis release for tennis elbow.

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A new method to locate the radial head “safe zone” on computed tomography axial views

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2017.10.013 ◽

2018 ◽

Vol 104 (1) ◽

pp. 71-77 ◽

Cited By ~ 3

Author(s):

Y. Zhan ◽

C.F. Luo ◽

Y.J. Chen

Keyword(s):

Computed Tomography ◽

Radial Head ◽

Safe Zone ◽

New Method

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Safe Zone for C1 Lateral Mass Screws: Anatomic and Radiological Study

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2011.05.041 ◽

2011 ◽

Vol 2011 ◽

pp. 311-312

Author(s):

R. Riesenburger

Keyword(s):

Safe Zone ◽

Lateral Mass ◽

Radiological Study ◽

Lateral Mass Screws

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Osteosynthesis of Combined Injuries of the Capitellum humeri and the Radial Head

Swiss Surgery ◽

10.1024/1023-9332.9.6.275 ◽

2003 ◽

Vol 9 (6) ◽

pp. 275-282

Author(s):

Ott ◽

Rikli ◽

Babst

Keyword(s):

Range Of Motion ◽

Radial Head ◽

Performance Score ◽

Anatomische Rekonstruktion ◽

Mayo Elbow Performance Score ◽

Capitulum Humeri ◽

Combined Injuries

Einleitung: Kombinierte Verletzungen des Capitulum humeri und des Radiusköpfchens sind selten. Meist sind neben den osteocartilaginären Schäden am Gelenk auch Verletzungen der Kollateralbänder assoziiert. Behandlungsempfehlungen für diese seltenen schwerwiegenden Ellenbogenverletzungen fehlen. Studientyp: In einer retrospektiven Analyse werden fünf Fälle untersucht, bei denen die osteocartilaginären Verletzungen des Capitulum humeri durch den gleichen Zugang, der zur Versorgung des Radiusköpfchens verwendet wurde, versorgt wurden. Die Osteosynthese erfolgte mit Mini-Titanimplantaten z.T. kombiniert mit resorbierbaren Pins. Patienten und Methode: Zwischen 1996-1999 wurden fünf Patienten (vier Männer, eine Frau) mit einer Kombinationsverletzung von Radiuskopf und Capitulum humeri operativ stabilisiert. Das Durchschnittsalter beträgt 34 Jahre (31-40 Jahre). Alle Frakturen wurden über einen direkten radialen Zugang mittels 1.5mm oder 2.0mm Zugschrauben, zum Teil mit resorbierbaren Pins stabilisiert. Anschliessend wurden die Patienten radiologisch und klinisch gemäss dem Mayo-elbow-performance Score beurteilt. Resultate: Alle Patienten konnten persönlich durch einen nicht in die Initialtherapie involvierten Untersucher nach durchschnittlich 12.8 Monaten (8-24 Monate) nachuntersucht werden. 4/5 Patienten konnten bezüglich ihrer subjektiven Einschätzung befragt werden. Radiologische Zeichen einer Nekrose des Capitulum humeri oder Arthrosezeichen fanden sich nicht. Bei drei Patienten fanden sich periartikuläre Verkalkungen. Der range of motion beträgt durchschnittlich 124 Grad (Extension 5-30 Grad, Flexion 110-145 Grad) in drei von fünf Fällen waren Sekundäreingriffe zu Mobilitätsverbesserung nötig. Der Mayo-elbow-performance Score beträgt im Mittel 85 Punkte (range 70-100 Punkte). Schlussfolgerung: Die direkte Verschraubung mit Miniimplantaten zum Teil in Kombination mit resorbierbaren Pins ermöglicht eine stabile anatomische Rekonstruktion des Capitulum humeri durch den gleichen Zugang wie er für die Stabilisierung des Radiusköpfchens notwendig ist. Die transartikuläre Fixation der kleinen Schalenfragmente des Capitulum humeri erlaubt eine sichere interfragmentäre Kompression und damit eine frühfunktionelle Rehabilitation. Sekundäreingriffe zur Verbesserung der Gelenkbeweglichkeit waren in drei von fünf Fällen nötig.

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