| A traumatized elbow i.e. a radial head fracture can be very invalidating if not treated according to the principles of open reduction and stable fixation. Immediate motion is a keystone factor to obtain a nearly normal or normal elbow function. Comminutive radial head fractures which are nearly always associated with ligamental injuries and which are not suitable for open reduction and stable fixation can be treated either with a radial head resection or a radial head replacement. Due to the relative high complication rate of a radial head resection, radial head replacement is a more suitable option. Although short to medium term results of radial head replacements are satisfactory, some series as our own report of malfunctioning in a number of cases. In a closer look at those failures we identified lengthening or shortening of the radial neck in a number of cases due to malpositioning of the radial head prosthesis as a potential deleterious factor in patients with a radial head replacement. Other investigators sheared our opinion. We therefore started an experimental study on a human cadaver elbow model with the aim to determine the effect of lengthening or shortening of the radial neck on elbow biomechanics. We demonstrated altered kinematics associated with a change of length of more than 2,5 mm of the radial neck and elevated pressures in the elbow if the radial neck was lengthened more than 2,5 mm. These data are the basis to start a cadaveric study determine precise, useful and reproducible anatomical landmarks at the elbow to aid the surgeon in reconstructing the native radial neck.; These findings may also be of some significance in the development of a new generation of radial head implants and in the development of a tricompartimental total elbow prosthesis.; Finally, based on our experimental biomechanical findings I would recommend, whenever a patient needs a radial head prosthetic device, to implant it as accurate as possible within a 2,5 mm length margin and to consider this surgical intervention with as much detail as any other "established" joint replacement surgery. |
