The Journal of Bone and Joint Surgery (American). 2008;90:63-73.
doi:10.2106/JBJS.G.01248
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Radial Head Arthroplasty with a Modular Metal Spacer to Treat Acute Traumatic Elbow Instability

Surgical Technique

David Ring, MD, PhD1 and Graham King, MD, MSc, FRCSC2

1 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org
2 Hand and Upper Limb Centre, St. Joseph's Health Centre, 268 Grosvenor Street, London, ON N6A 4L6, Canada

Investigation performed at the Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, Massachusetts, and St. Joseph's Health Centre, London, Ontario, Canada

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 1075-80, May 2007

DISCLOSURE: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Wright Medical Group, Inc. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Hand and Upper Limb Centre, UWO Research Fund) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

A video supplement to this article has been produced by the Video Journal of Orthopaedics (VJO). This production is included on the bound-in DVD as part of this issue and will also be available in streaming video format at the JBJS website, www.jbjs.org. VJO can be contacted at (805) 962-3410, web site: www.vjortho.com.

BACKGROUND: The use of a metal radial head prosthesis to help stabilize an elbow with traumatic instability is appealing because internal fixation of multifragment, displaced fractures of the radial head is susceptible to either early or late failure. The newer modular prostheses are easier to size and implant, but their effectiveness has not been investigated, to our knowledge.

METHODS: Twenty-seven patients in whom a radial head replacement with a modular metal spacer prosthesis had been performed to treat traumatic elbow instability were evaluated with use of the Mayo Elbow Performance Index (MEPI), the American Shoulder and Elbow Surgeons Elbow Evaluation Instrument (ASES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiographs were evaluated for arthrosis, periprosthetic radiolucency, and heterotopic ossification.

RESULTS: Seven patients underwent one or more subsequent operations to treat residual instability, heterotopic ossification and elbow contracture, ulnar neuropathy, or a misplaced screw. In two of these patients, the prosthesis was removed as part of an elbow contracture release or to treat infection. At an average of forty months postoperatively, elbow motion in the entire group of twenty-seven patients averaged 131° of flexion with a 20° flexion contracture, 73° of pronation, and 57° of supination. Stability was restored to all twenty-seven elbows, and twenty-two patients had a good or excellent result according to the MEPI. Seventeen patients had radiographic evidence of lucency around the neck of the prosthesis that was not associated with increased pain, thirteen patients had clinically inconsequential heterotopic ossification anterior to the radial neck, and nine patients had radiographic changes in the capitellum.

CONCLUSIONS: An intentionally loosely placed modular metal radial head prosthesis can help to restore stability in conjunction with repair of other fractures and reattachment of the lateral collateral ligament to the epicondyle in the setting of traumatic elbow instability with a comminuted fracture of the radial head. While a prosthesis that is too large can cause problems, lucencies around the stem of the intentionally loose prosthesis and most changes in the capitellum do not appear to cause problems, at least in the short term.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Radial Head Arthroplasty with a Modular Metal Spacer to Treat Acute Traumatic Elbow Instability" (2007;89:1075-80).


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