The ulna, radius and humerus articulate in such a way as to form four distinctive joints. If replacement of the radial head is necessary, the surgeon must make preoperative decisions regarding the implant and surgical approach. For primary and revision joint replacement of the radial head. Fashion removable longarm splint holding the elbow in 90 degrees.
Anatomic radial head prosthesis is a unique implant that closely replicates the natural anatomy of the patients radial head. Rhap avoids the tenuous fracture fixation in the setting of an associated injury where maintenance of joint stability would be compromised by inefficient fracture fixation 8, 23, 24. Failure of a unipolar radial head prosthesis due to component. Monopolar and bipolar radial head prosthetic arthroplasties have been used successfully to treat elbow fracturedislocation with unsalvageable radial head fractures. Many innovative design features are incorporated into the implant heads and stems, as well as the instrumentation to improve the surgical technique. It is the policy of health plans affiliated with centene corporation that radial head implants are medically necessary when meeting the following. Splint to be worn full time except for when performing therapy exercises for the rst 6 weeks. Treatment of sequelae of radial head fractures with a bipolar radial head prosthesis. Using a microsagittal saw, resect any remaining radial head at the level of the radial neck, perpendicular to the axis of the neck figures 1 and 2.
Pdf radial head fractures are a particularly common yet challenging problem facing orthopedic surgeons today. Select a trial head that appears to correctly fill the gap. Radial head reconstruction in elbow fracturedislocation. Simple design has no polyethylene, moving parts, or set screws. Synthes radial head prosthesis system, surgical instrument motors and accessories product usage. For primary and revision joint replacement of the radial.
Jun 12, 2017 associated radial head prosthesis system parts also need to be returned to depuy synthes but will be available for revision surgeries of the radial head component. Implantation of a radial head prosthesis rhp restores the lateral column and ensures both elbow stability in the coronal plane and vertical stability of. Our study demonstrates excellent longterm implant survival. Resection of the radial head for fracture of the radial head. The acumed anatomic radial head prosthesis is designed to provide a precise anatomical implant to replace the patients native radial head. The rhs implant has been designed to maintain congruence between the prosthesis, distal humerus and proximal ulna. Because the anatomy of the radial head is difficult to reproduce with a prosthesis, two different options have been proposed. Using mason classification, type 1 nondisplaced partial fractures are usually treated nonoperatively. The head portion may be configured to be a placed onto the stem portion by movement of the head and stem portions relative to one another transverse to. Surgeons have emphasized the importance of restoring the biomechanical properties of the native radial head when radial head replacement is indicated. Anatomic radial head system surgical technique acumed. Use the normal or long radial head resection guide to mark the level. According to depuy synthes 1, the system is indicated for the replacement of the radial head for degenerative or posttraumatic disabilities. In the present report, we describe a case of such injury with irreparable radial head treated with patientspecific radial head prosthesis which was created.
A round radial head prosthesis is nonanatomic and therefore does. The radial head prosthesis aims to prevent significant change in the anatomy of the forearm and wrist. Explor modular radial head surgical technique zimmer biomet. Intraoperative fluoroscopic assessment of proper prosthetic. The results of these analyses are summarized in table ii.
Guide the trial head onto the trial stem by hand or using. Radial head prosthesis system for primary and revision joint replacement of the radial head integrated connection screw captivated in head articulating dish dish depth grows 0. Radial head prosthesis implants consist of uncemented fixation stems and radial heads. Radial head arthroplasty modern implants unipolar or bipolar, monoblock or modular, anatomical or nonanatomical, cemented or pressfit correct diameter, height, medial offset and cervicocephalic angle bipolarity permits an automatic positioning of the radial head with respect to the neck and the opposite. Complications of radial head prostheses springerlink.
The authors describe their case studies and results on the implantation of various radial head prostheses. Radius head prosthesis an overview sciencedirect topics. Ensure that you are familiar with the appropriate surgical technique. In this form, it is important to recognize and restore the osseous stabilizer in order to obtain the concentric reduction. The purposes of this study were to investigate the longterm outcomes of radial head replacement and to analyze the relationship between functional outcomes and periprosthetic radiolucency. Successful treatment of the chronic persistent elbow instability is a challenge for orthopedic surgeons. Bipolar radial head prosthesis with a smooth cementless stem effectively restores elbow stability and function after comminuted radial head fractures with or without concomitant elbow instability. Aug 14, 2017 radial head replacement is frequently used in treatment of radial head fractures or sequela.
Without the radiohumeral joint, loading on the ulnohumeral. The indications for use of a metallic radial head prosthesis include an acute comminuted fracture in which satisfactory reduction and stable fixation cannot be obtained. In exemplary embodiments, the prosthesis is a radial head prosthesis having a stem portion and a head portion. System, including methods and apparatus, for replacing an end of a bone, such as a radial bone, with a prosthesis. Following placement of the trial head, place the elbow through a full range of elbow flexionextension and forearm pronationsupination. Background metal prostheses are useful for restoring elbow and forearm stability when the radial head cannot be fixed after a fracture. Rhap provides a reasonable option in such a scenario 9,21.
Metallic pressfit radial head replacement for radial head. Featuring 10 left and right anatomically shaped radial head implants and 20 stem options, the system provides 200 headstem combinations to accommodate each patients anatomy. A comparative study between proximal radial morphology and the floating radial head prosthesis. Radial head replacement is frequently used in treatment of radial head fractures or sequela. Indications the radial head prosthesis system is indicated for primary replacement of the radial head after. Radial head prosthesis surgical technique depuy synthes 15 trial heads can be attached to the trial or definitive stem for determination of the implant height. Floating radial head prosthesis for comminuted radial head fractures. Intended for primary and revision joint replacement of the radial head.
A radial head prosthesis that is too long leads to overlengthening of the radius or overstuffing of the radiocapitellar joint and can cause articular cartilage erosion at the capitellum, loss of elbow motion, pain, and posttraumatic arthritis. Data on patient characteristics including age, gender, injury complexity, associated trauma. The radial head resection guide has two resection levels. Radial head replacement may also be considered in patients with complex elbow injuries that involve greater than 30% of the articular rim of the radial head, which cannot. Nov 29, 2014 the purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis. Radial head arthroplasty is indicated in the treat ment of radial head or neck fractures when comminution precludes stable internal fixation of an unstable. The literature describes various options for the treatment of fractures of the radial head, including orif, radial head resection or prosthesis but, in most traumas and fractures, where it is important to reconstruct the radial head and the radiohumeral contact, the choice is between osteosynthesis and replacement. By replacing the radial head, the prosthesis is meant to restore the joint function of the elbow. Radial head fracture repair and rehabilitation surgical indications and considerations anatomical considerations. Radial head replacement with pyrocarbon prosthesis. Radial head arthroplasty is a favourable technique for the treatment of comp.
Radial head fractures account for approximately onethird of all adult elbow fractures. Longterm outcomes of modular metal prosthesis replacement in. The radius runs from the wrist to the elbow and the end of the radius at the elbow is a round prominence known as the radial head. Novel implants and improved surgical techniques have made reconstruction of the radial head with open reduction and internal fixation possible in most cases. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications.
Partial radial head arthroplasty jses international. Radial head implant, or arthroplasty, was developed for. The elbow is a complex joint due to its intricate functional anatomy. Radial head fracture, radial head replacement, prosthesis, radiolucency background as up to 60% of the force transmits across the radiocapitellar joint 1, the radial head plays an important role in elbow mechanics 2 and serves as a secondary constraint to valgus axial strain 3. Radial head replacement with the mopyc pyrocarbon prosthesis. The external fixator was removed at 2 weeks because of pin site infection, and dissociation of the radial head prosthesis followed. Failure of a unipolar radial head prosthesis due to. Lateral view of a radial head replacement in an elbow showing marked widening of the bonecement interface and thinning of the radial cortex related to aseptic loosening. Confidence in over 25,000 sold4 modular stem and head provide over 320 size combinations to match variable anatomy smooth stem implant design supported by two long term studies 8year1 and 12 year2 average follow up simple design has no polyethylene, moving parts or set screws to wear out over time prospective data show proven performance.
Inspection of the radial head and trauma to the neck will determine if the standard or long radial head implant will be used. Anatomic radial head system provides a comprehensive solution for radial head replacement. The radial head is an important stabilizer of the elbow joint providing valgus and axial stability to the elbow and forearm. The radial head is the part of the radius bone closest to the elbow. Explor modular radial head trial reduction continued slide the slot located on the undersurface of the radial head along the ridge located on the proximal radial stem until the head is fully seated figure 10. Radial head the radial neck is cut using a sagittal saw to create a flat surface perpendicular to the radial neck axis. One of the biggest dangers of elbow implant loosening is that it is difficult to diagnose. Anatomic radial head brochure and surgical technique acumed.
The prosthesis has moved in position, a finding diagnostic for loosening. Radial head arthroplasty with a modular prosthesis initial. Request pdf reference points for radial head prosthesis size metallic radial head implants are useful when the radial head cannot be repaired reliably and. Abstract background comminuted radial head fractures are challenging to treat with open reduction and internal fixation. Smooth stem implant designs supported by two long term studies 12year 1 and 8year 2 mean follow up modular stem and head design provides 324 size combinations. Typically caused by a fall on an outstretched arm, rhfs occur in younger, working individuals with mean age range of 30 years to 40 years 1,2,4,5. Radial head prosthesis oskar radial head replacement. Longterm outcomes of modular metal prosthesis replacement. A 2012 study published in the journal of shoulder and elbow surgery called the guidelines for diagnosing a loose radial head prosthesis lacking. When the radius bone migrates, it can lead to chronic wrist pain. Anatomic radial head prosthesis is a unique implant that closely replicates the. Type 2 partial marginal fractures involving 2 mm of displacement are usually treated with open reduction and internal.
The radial head replacement is utilized to help prevent movement of the radius bone. The treatment of complex radial head fractures remains a challenge for the orthopedic surgeon. This is the knobby end of the radius, the bone on the thumb side of the lower arm. However, replacement with a metal implant can change the biomechanics of the. The lower end of the arm bone humerus joins with the two bones that form the forearm radius and ulna. Note track red arrow from prior external fixator pin placement has filled in on the follow up study. The device consists of a head that replaces the natural radial head and a stem that is inserted into the radius. However, extremely comminuted radial head fractures with associated instabilities still require replacement of the radial head. When a radial head prosthesis is deemed to be necessary for the management of failed internal fixation or failed arthroplasty, but the amount of capitellar damage is concerning, consideration can be given to a unicompartmental replacement. It is the state of the art for modular radial head arthroplasty.
The purpose of this study was to report the preoperative complaints and postoperative outcome of patients after removal of the radial head prosthesis. Radial head prostheses are indicated for treatment of complex radial head fractures not amenable for fixation. Sixty percent of compressive loads are transferred across the radiohumeral joint fig. If necessary, use a provisional set screw to secure the radial head to the radial stem. Such fractures are generally treated by excision or by radial head arthroplasty. After the initial experience with silastic implants, metallic or pyrocarbon arthroplasty have been used for 20 years. Radial head fracture explanation of procedure andor diagnosis anatomy the elbow joint is made up of three bones.
Prosthesis, elbow, hemi, radial, polymer product code kwi. Maartensclinic, po box 9011, nl6500 gm nijmegen, the netherlands. Pdf radial head prostheses rhp have been developed to decrease the complications rate following a radial head resection surgery. Featuring 10 left and right anatomically shaped radial head implants and 20 stem options, the system provides 200 head stem combinations to accommodate each patients anatomy. Primary replacement after fracture of the radial head symptomatic sequelae after radial head resection contraindications bone musculature, tendons, or adjacent soft tissue compromised by disease, infection. Despite the expanding body of literature on radial head arthroplasty, the increasing understanding of elbow anatomy, biomechanics, and kinetics, and the evolution of surgical techniques and prosthesis designs, there is currently no evidence to support one type of radial head prosthesis over another. Aim of this study is to present the clinical, functional, and radiographic midterm results in patients who sustained a radial head fracture and subsequently underwent treatment with the mopyc pyrocarbon prosthesis bioprofile, tornier, saintismier, france.
By providing the patient with an anatomical prosthesis, wear on the. Among the latest types of radial head prostheses that are currently being used is the modular pyrocarbon radial head prosthesis. Radial head fractures rhf constitute onethird of the fractures around the elbow joint and 1. Radial heads dtj301 18 mm dtj302 20 mm dtj303 22 mm dtj304 24 mm references 1. Most of the available implants will help restore lateral stability, however, the surgeon must decide if he or she. Prior templating of the xray will also assist in determining which radial head will be used. Patient education radial head fracture the core institute. Radial head prosthesis surgical technique depuy synthes 1 2 resect radial head if the radial head is fractured and is not repairable, remove the fragments to ensure no bone is left in the joint. The depuy synthes radial head prosthesis system is designed to replace the arms natural radial head. The radial head prosthesis is intended for partial replacement of the elbow joint by primary or revision applications. Radial head prosthesis please read these instructions for use, the synthes brochure important information and the corresponding surgical techniques carefully before use.
Selecting a radial head prosthesis that can closely replicate the anatomy of the native proximal radius is of. Radial head arthroplasty with a modular prosthesis. Evolve proline modular radial head system wright medical group. Reference points for radial head prosthesis size request pdf. The smooth stem design continues to be utilized and is now supported by. The relative stability of these two designs in different clinical situations is a topic of ongoing investigation. Manufacturer of radial head prosthesis oskar radial head replacement offered by biotek chetan meditech pvt. A highspeed burr can also be used to remove irregularities or prominences at the end of the radial neck. Mar 03, 2014 the replacement of radial head hereafter referred to as radial head arthroplasty. Joaquin sanchezsotelo, in morreys the elbow and its disorders fifth edition, 2018.