fracture radial head
-
Upload
ortho-rifle -
Category
Health & Medicine
-
view
116 -
download
3
Transcript of fracture radial head
![Page 1: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/1.jpg)
Isolated radial head fractures
![Page 2: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/2.jpg)
ISOLATED RADIAL HEAD FRACTURES
Kc gopalakrishnan
![Page 3: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/3.jpg)
1.5 to 4 % of all fractures in adult
33 % of all elbow injuries
![Page 4: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/4.jpg)
Isolated Radial head fractures
• Davidson et al- all 111 patients with entire radial head fractures had associated wrist or elbow ligamentous injury( clin orthop 1993)
• 30 – 70% associated injuries in various studies
![Page 5: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/5.jpg)
Isolated Radial head fractures
• Rockwood and Green- assume associated injuries unless proved otherwise
![Page 6: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/6.jpg)
Isolated Radial head fractures
• Possible to get isolated radial head fractures in elderly but rare -Rockwood and Green
![Page 7: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/7.jpg)
Isolated Radial head fractures
• “Entire radial head fracture or displaced partial radial head fracture always associated with ligamentous injury-” Rockwood and Green
![Page 8: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/8.jpg)
ISOLATED RADIAL HEAD FRACTURE
![Page 10: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/10.jpg)
APPLIED ANATOMY• Radial head act as secondary
stabilizer to valgus stress, primary being MCL
• Radial head resection in presence of intact MCL does not alter valgus instability much
![Page 11: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/11.jpg)
APPLIED ANATOMY
• PROXIMAL RADIO ULNAR JOINT
»260* arc covered with articular cartilage
»100* arc safe zone
»Pronation-supination
![Page 12: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/12.jpg)
APPLIED ANATOMY• RADIO
CAPITELLAR JOINT
• Radial head transmits 60% of axial load of forearm to capitellum (Morrey JBJS 1988)
![Page 13: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/13.jpg)
APPLIED ANATOMY• RADIO
CAPITELLARJOINT
This load is greatest with forearm in pronation and b/w 0-30* elbow flexion
![Page 14: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/14.jpg)
MECHANISM OF INJURY
– Indierect injury– Axial load thru pronated forearm– Valgus injury– Posterolateral rotatory load
![Page 15: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/15.jpg)
MECHANISM OF INJURY
![Page 16: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/16.jpg)
MECHANISM OF INJURY
• Disruption of interroseous membrane due to acute shortening of radius producing longitudinal traction
![Page 17: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/17.jpg)
ASSOCIATED INJURIES
ELBOW DISLOCATIONESSEX LOPRESTI
CAPITELLUM FRACTURECORONOID FRACTURE
![Page 18: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/18.jpg)
ASSOCIATED INJURIES
MCL injury Olecranon
fraccture dislocation
![Page 19: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/19.jpg)
Detecting associated associated injuries
• Clinical examination• X-ray evaluation• CT• Intraoperative evaluation
![Page 20: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/20.jpg)
Detecting associated associated injuries
![Page 21: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/21.jpg)
CLINICAL EVALUATION
• Even minor fractures are painful due to haemarthrosis
• Document forearm rotation after LA injection to joint to rule out mechanical block
![Page 22: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/22.jpg)
DOCUMENT• MCL injury• PIN injury • DRUJ injury
Interroseous membrane injury
![Page 23: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/23.jpg)
DOCUMENT• • • •
![Page 24: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/24.jpg)
BROBERG MORREY MODIFICATION OF MASON CLASSIFICATION 1
• Marginal/ segmental fracture• < 2mm displacement• No block to forearm rotation
![Page 25: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/25.jpg)
BROBERG MORREY MODIFICATION OF MASON
CLASSIFICATION 2
• Displaced segmental fracture• > 2mm/ >30* angulation• Mechanical block to forearm rotation
![Page 26: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/26.jpg)
BROBERG MORREY MODIFICATION OF MASON
CLASSIFICATION 3
• Communited entire radial head fracture
![Page 27: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/27.jpg)
BROBERG MORREY MODIFICATION OF MASON
CLASSIFICATION 4
• Radial head fracture associated with elbow dislocation
![Page 28: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/28.jpg)
HOTCHKISS MODIFICATION OF MASON
CLASSIFICATION• TYPE 1- minimally displaced radial head
fracture , no block to forearm rotation, can be treated non operatively
![Page 29: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/29.jpg)
HOTCHKISS MODIFICATION OF MASON
CLASSIFICATION• TYPE 2- displaced partial radial head
fracture that blocks forearm rotation/ entire radial head fracture amenable to fixation, treatment is ORIF
![Page 30: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/30.jpg)
HOTCHKISS MODIFICATION OF MASON
CLASSIFICATION• TYPE 3- communited entire radial head
fracture not amenable to fixation, radial head excision or replacement .
![Page 31: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/31.jpg)
Goals of treatment• Correcton of block to free forearm
rotation• Stable elbow• Prevent late arthrosis• Early mobilisation
![Page 32: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/32.jpg)
Non operative treatment• Modified mason 1 fractures• No associated lig injuries• No bony block to ROM
![Page 33: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/33.jpg)
Non operative treatment• Early(3-4d) ROM • Large undisplaced fragments need to be
monitored with x-ray• Loss of elbow extension• Redisplacement• Non union
• Various studies have reported 90% favourable results in mason 1 injury
![Page 34: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/34.jpg)
Non operative treatment• 80% favourable result with
MASON 2&3 fractures treated nonoperatively and added with delayed radial head excision when required for pain(JBJS (Am) :86-A; 3, 570.)
![Page 35: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/35.jpg)
Non Operative Rx
![Page 36: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/36.jpg)
More than 2 wks POP
![Page 37: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/37.jpg)
Retain/Regain
![Page 38: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/38.jpg)
![Page 39: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/39.jpg)
Safe Zone• Smith and hotchkiss• 65* ant and 45* pos to line
bisecting anterior and pos head with arm in neutral rotation
![Page 40: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/40.jpg)
Safe Zone
![Page 41: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/41.jpg)
ORIF. implant in SAFE ZONE
![Page 42: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/42.jpg)
CONSIDER ORIF • Displaced MASON 2(>2mm)
partial radial head fractures which block forearm rotations
• Entire radial head fractures with unstable elbow if
– Less than three articular fragments– Sufficient size and bone quality ti accept
screws– No metaphyseal bone loss
![Page 43: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/43.jpg)
Partial radial head fracture
![Page 44: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/44.jpg)
Entire radial head fracture
![Page 45: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/45.jpg)
• Better understanding of anatomy and safezones for implant and current implants have improved clinical results of internal fixation
• King et al have repoted 100% excellent results with internal fixation for Mason 2 fractures
• They have reported only 33%good results with Mason 3 fractures treated by internal fixation
![Page 46: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/46.jpg)
• Due to inadequate fixation or selection of fracture pattern- include
• Nonunion• Restriction of forearm motion• Implant failure • Infection • PIN injury
![Page 47: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/47.jpg)
Inadequate fixation
![Page 48: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/48.jpg)
Extending the indication
![Page 49: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/49.jpg)
Primary Radial head excision
![Page 50: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/50.jpg)
Primary Radial head excision
Modified mason 3 fractures with» Intact MCL » No injury to DRUJ» Coronoid and
olecranon intact• Partial radial head fractures
hindering forearm rotation not amenable to reconstruction
![Page 51: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/51.jpg)
15 yr follow up studies• Antuna et al- 81 % painfree ,
radigraphic OA did not produce clinical symptoms
• Hebertson et al- 90% excellent results, OA changes in 50%
![Page 52: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/52.jpg)
COMPLICATIONS• LOSS OF ELBOW MOTION• LOSS OF STRENGTH• ELBOW OA CHANGES• PROXIMAL MIGRATION OF
RADIUS( up to 2 mm assymptomatic)
• WRIST PAIN• VALGUS INSTABILITY OF ELBOW
![Page 53: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/53.jpg)
EVOLVING
?
![Page 54: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/54.jpg)
Radal head arthroplasty
• Silicone prosthesis• Insabilty• Destructive synovitis • Discarded
• Metal prosthesis– Press fit / cemented– Smooth stem – Unipolar or modular bipolar head
![Page 55: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/55.jpg)
• Smooth stem• Act like spacer• Produce
radiolucencies but asymptomatic
• No overstuffing of radiocapitellar joint
![Page 56: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/56.jpg)
• Fixed stem• Overstuffing if radiocapitellar joint if
prosthesis more than 1 mm proximal to coronoid process
• Open up elbow on lateral side• Capitellar wear and synovitis• So exact sizing must
• No significant diff b/w monopolar or bipolar heads
![Page 57: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/57.jpg)
Over stuffing with opening up
![Page 58: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/58.jpg)
TAKE HOME MESSAGE• Isolated radial head fracture do
occur but is rare• Always look for wrist or elbow
ligamentous injury• Document forearm rotation• Nonoperative treatment involves
supervised mobilization NOT immobilization
![Page 59: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/59.jpg)
TAKE HOME MESSAGE
• Selection of type of fracture amenable to fixation crucial
• Follow safe zones for implants• Radial head arthroplasty is
still evolving
![Page 60: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/60.jpg)
DIDN’T MEAN TO CONFUSE!!!!!!!!!!
![Page 61: fracture radial head](https://reader035.fdocuments.in/reader035/viewer/2022062900/58ececa41a28aba2548b45ff/html5/thumbnails/61.jpg)