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

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.

Download Full-text

Radial head fractures

Shoulder & Elbow ◽

10.1177/1758573219876921 ◽

2019 ◽

Vol 12 (3) ◽

pp. 212-223 ◽

Cited By ~ 1

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.

Download Full-text

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

Shoulder & Elbow ◽

10.1177/1758573219839225 ◽

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.

Download Full-text

Radial Head Arthroplasty with A Modular Prosthesis – Initial Experience

Acta Medica Bulgarica ◽

10.1515/amb-2016-0006 ◽

2016 ◽

Vol 43 (1) ◽

pp. 47-53

Author(s):

V. Petrov ◽

B. Matev ◽

D. Dikov

Keyword(s):

Radial Head ◽

Load Transfer ◽

English Literature ◽

Late Complications ◽

Initial Experience ◽

Severe Injuries ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Type Iii ◽

Joint Dislocations

SummaryThe Mason type III and IV radial head fractures are severe injuries that lead to decreased range of motion, alteration in the kinematics, the load transfer and the stability of the elbow. They are often in conjunction with ligament injuries, anterior or posterior joint dislocations and fractures of the coronoid process, the humeral capitulum and the olecranon. The resection of the head leads to elbow instability, late complications and arthrosis of the elbow. The open reduction and internal fixation (ORIF) in Mason type III and IV fractures is not able to restore and sustain the anatomical structure and function of the radiocapitellar joint. That is why these fractures require arthroplasty. The best results are reported with the use of metal bipolar prosthetics. We present our initial experience with radial head arthroplasty on three patients with mean follow up 18 months and a review of the English literature.

Download Full-text

Chronic Posttraumatic Anterior Dislocation of the Radial Head in Children: Thirteen Cases Treated by Open Reduction, Ulnar Osteotomy, and Annular Ligament Reconstruction Through a Boyd Incision

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70052-x ◽

2007 ◽

Vol 2007 ◽

pp. 48-49

Author(s):

H.A. Peterson

Keyword(s):

Radial Head ◽

Open Reduction ◽

Ligament Reconstruction ◽

Anterior Dislocation ◽

Annular Ligament ◽

Ulnar Osteotomy ◽

Annular Ligament Reconstruction

Download Full-text

Kinematic analysis of two scapholunate ligament reconstruction techniques

Journal of Orthopaedic Surgery ◽

10.1177/23094990211025830 ◽

2021 ◽

Vol 29 (2) ◽

pp. 230949902110258

Author(s):

Seungbum Chae ◽

Junho Nam ◽

Il-Jung Park ◽

Steven S. Shin ◽

Michelle H. McGarry ◽

...

Keyword(s):

Kinematic Analysis ◽

Clinical Relevance ◽

Ligament Reconstruction ◽

Operative Time ◽

Efficient Technique ◽

Scapholunate Ligament ◽

Interosseous Ligament ◽

Flexion Extension

Purpose: This study compares the kinematic changes after the procedures for scapholunate interosseous ligament (SLIL) reconstruction—the modified Brunelli technique (MBT) and Mark Henry’s technique (MHT). Methods: Ten cadaveric wrists were used. The scapholunate (SL) interval and angle and radiolunate (RL) angle were recorded using the MicroScribe system. The SL interval was measured by dividing the volar and dorsal portions. Four motions of the wrist were performed—neutral, flexion, extension, and clenched fist (CF) positions—and compared among five conditions: (1) intact wrist, (2) volar SLIL resection, (3) whole SLIL resection, (4) MBT reconstruction, and (5) MHT reconstruction. Results: Under the whole SLIL resection condition, the dorsal SL intervals were widened in all positions. In all positions, the dorsal SL intervals were restored after MBT and MHT. The volar SL interval widened in the extension position after volar SLIL resection. The volar SL interval was not restored in the extension position after MBT and MHT. The SL angle increased in the neutral and CF positions under the whole SLIL resection condition. The SL angle was not restored in the neutral and CF positions after MBT and MHT. The RL angle increased in the neutral and CF positions under the whole SLIL resection condition. The RL angle was not restored in the neutral and CF positions after MBT and MHT. Conclusion: The MBT and MHT may restore the dorsal SL interval. No significant differences in restoration of the SL interval between MBT and MHT were found in the cadaveric models. Clinical relevance: No significant differences between MBT and MHT were found in the cadaveric models for SLIL reconstruction. When considering the complications due to volar incision and additional procedures in MHT, MBT may be a more efficient technique in terms of operative time and injury of the anterior structures during surgery, but further research is needed.

Download Full-text

Radial Head Fractures

Evidence‐Based Orthopedics ◽

10.1002/9781119413936.ch84 ◽

2021 ◽

pp. 505-508

Author(s):

James D. Spearman ◽

David Ring ◽

Lee M. Reichel

Keyword(s):

Radial Head ◽

Radial Head Fractures

Download Full-text

Radial head fractures associated with elbow dislocations treated by immediate stabilization and early motion

Journal of Shoulder and Elbow Surgery ◽

10.1016/s1058-2746(99)90160-x ◽

1999 ◽

Vol 8 (4) ◽

pp. 355-360 ◽

Cited By ~ 57

Author(s):

M FRANKLE

Keyword(s):

Radial Head ◽

Radial Head Fractures ◽

Early Motion

Download Full-text

Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-018-2214-4 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Guanyi Liu ◽

Erman Chen ◽

Dingli Xu ◽

Weihu Ma ◽

Leijie Zhou ◽

...

Keyword(s):

Internal Fixation ◽

Radial Head ◽

Open Reduction ◽

Bone Grafts ◽

Type Ii ◽

Radial Head Fractures

Download Full-text

INTERNAL FIXATION OF RADIAL HEAD FRACTURES WITH AN INTRAMEDULLARY NAIL

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237213500075 ◽

2013 ◽

Vol 25 (01) ◽

pp. 1350007

Author(s):

Matija Krkovic ◽

Miha Brojan ◽

David Bombac ◽

Dejan Hermann

Keyword(s):

Intramedullary Nail ◽

Radial Head ◽

Radial Head Fracture ◽

Vascular Supply ◽

General Idea ◽

Stable Fixation ◽

Radial Head Fractures ◽

Design And Manufacturing ◽

Comminuted Fractures ◽

Thin Walled

Comminuted fractures of the radial head still present significant technical and surgical challenges. In this article, we describe a novel fixation of comminuted radial head fractures with the help of an intramedullary nail. Experiments with solid, conventionally machined intramedullary nails showed some major drawbacks in the fixation of radial head fractures. Several design and manufacturing procedures were proposed. The general idea behind the new design was the concept of a nail which would eliminate the need for prefabricated bores. Experiments with a selective laser sintered thin-walled nail, designed with the help of CT images, fulfilled expectations. This thin-walled proximal radius nail thus offers a stable fixation of the radial head fracture fragments, with the ability to preserve the existing vascular supply to the radial head fragments, and therefore not just use the reconstructed radial head as a bioprosthesis.

Download Full-text