Artificial Radial Head Prosthesis Replacement For The Treatment Of Comminuted Radial Head Fracture

Objective:Evaluation of retrospective study using artificial radial head prosthesis replacement for the treatment of comminuted radial head fracture of the early effectsMaterials and Methods:1 Case InformationAll patients in this group are selected from the Jilin University, China-Japan Union Hospital (the original Norman Bethune Medical University, Third Clinical School of Medicine).Between February 2003 to December 2008 our orthopedic use artificial radial head prosthesis replacement for the treatment of 5 comminuted radial head fracture patients, three cases are male, two cases are female. Age 30 ~ 42 years old, average 36.4. Injury reasons: three cases of accidents, two cases of falling. Two cases are the left radial head fracture; three cases are the right radial head fracture. Four cases are fresh comminuted radial head fracture; one case is old radial head fracture. Typing by Mason, five cases all are MasonⅢtype. Operation time: four cases of fresh fractures after injury 5 ~ 14 days, an average of 9.2 days, one case of old fracture admitted to hospital for one month after injury. All five cases have been followed up for 8-15 months, an average of 11.6 months.2 Treatment(1)Preoperative preparation: All the patients were taken preoperatively bilateral elbow and wrist joints of 1︰1X-ray films in orthotopic and lateral. Record the function of bilateral elbow flexion and extension and rotation of all patients. All patients had the general application of antibiotics the day before surgery.(2)Surgical methods: Under brachial plexus anesthesia, the patient is positioned in a supine position with a sandbag placed underneath the ipsilateral shoulder to assist in positioning of the elbow across the chest and forearm pronate. The operative arm is placed over a padded bolster with a tourniquet in place. A posterolateral elbow incision is used. Through the elbow extensor and carpi ulnaris muscle and brachioradial expose humeroradial joint, and pull the extensor carpi ulnaris to the top of the lateral ulnar collateral ligament complex. Separate the radial collateral ligament and annular ligament longitudinally in the level of the radial head, and remove the broken radial head, and carried out in vitro splicing to confirm a complete resection, and no residual bone chip. In the proximal radial tuberosity osteotomy, retain 0.5cm proximal to radial tuberosity. Remove the radial head neck, and progressively expand the marrow. Select little larger prostheses than the test mode to insert to the proximal radial, and make sure the stem neck angle is same to angle of tilt of the proximal radial. Then test stability of the elbow flexion and extension and the forearm rotation. Flushing the modularly cavity, make sure the prosthesis insert in the correct position and angle of tilt of the prosthesis is the same to the angle of the proximal radial. After that, use the special equipment to pressure appropriately and make sure the prosthesis is very stable and prosthesis with humeral head cartilage surface maintain 1 to 2 mm pitch. Washing incision and repair articular capsule. Retention of vacuum-assisted and closure of incision are needed to be done carefully and well.(3)Postoperative processing: Fixed the operation arm with plaster limb after the elbow, elbow flexion from 90°, forearm neutral position. Postoperative use the antibiotics routinely to prevent infection, twice a day. Within 48 hours after operation remove drainage tube. One day after operation, that is, the guidance of elbow function in patients with rehabilitation exercises.Results:According to the Broberg and Morrey elbow functional score standard: excellent in 2 cases, good in 2 cases, less good in 1 case. Follow-up early X-ray are indications of radial head prosthesis after replacement of a good location, no loosening, dislocation, incision-free infection. There was not a case of the symptoms of radial nerve injury and metal foreign body reaction in 5 cases, and all the 5 cases were no apparent distal radioulnar joint dislocation anomalies. Only old radial head fractures in patients with heterotopic ossification there was a slight elbow joint activities in micro-feel pain, but patients can tolerate it, do not need further surgical treatment line.Conclusion: Artificial radial head replacement is a serious comminuted radial head treatment options, and its long-term results and follow-up need to be further explored. Surgical indications should be strictly controlled, surgery is not difficult, but careful preoperative preparation should be prepared, there is no surgical experience, doctors are advised not to try. After operating the intervention of science and rehabilitation is very important for functional recovery.