Radial head orif and arthroplasty phase 1 early protection of repair 0 4 weeks 1160 kepler drive 1 p a g e green bay, wi 54311 9202885555 goals for phase 1 protect radial head arthroplasty and healing structures minimize pain and edema initiate gentle active painfree range of motion mechanism was violated. Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability. The l2l radial head s simple design is intended to provide fit and comfort for the patient, and ease of implantation for the surgeon. With the anatomic radial head system,the surgeon is equipped with the tools needed to properly restore the patients anato.
Anatomic radial head system surgical technique acumed. Silastic radial head prosthesis in rheumatoid arthritis. Longterm outcomes of modular metal prosthesis replacement in. The harrington study,4 published in the journal of. Resecting the radial head radial head resection guide. Due to the elbow joints complex functional anatomy, the multifragmentary nature of many fractures and concomitant destabilizing associated injuries, dislocated fractures of the radial head and neck still. Pdf vitallium radial head prosthesis for acute and. The first radial head arthroplasty was performed by speed in 1941 8. Many prosthetic designs exist and can be unipolar or.
The contact mechanics and kinematics of radial head. 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. Pdf primary replacement of the fractured radial head. Radial head replacement has been used to treat or prevent this. The neck length gauges are used to determine the position of the radial neck cut or the length of the required neck when. The radial head replacement system allows for direct and radiographic visualization of the radiocapitellar, proximal radioulnar, and. The swanson titanium radial head implants have been sterilized and are available in five sizes to meet various operative requirements.
The stem of the titanium radial head implant has been shortened in length and enlarged in crosssection for improved ease of placement. The smooth stem design continues to be utilized and is now supported by numerous studies25 including two long term studies. The result may be less pain for the patient and a reduced chance of longterm prosthesis loosening. The mean duration of major elbow symptoms was 4 years range 1 to 8 years. Aug 14, 2017 radial head replacement is frequently used in treatment of radial head fractures or sequela. Prior templating of the xray will also assist in determining which. Impossibility to restore a correct anatomy, acute elbow traumatic instability and failure of osteosynthesis hardware are the most common indications. A number of radial head replacement rhr prostheses are currently available and approved by the united states food and drugadministration for the treatment of radial head fractures.
A highspeed burr can also be used to remove irregularities or prominences at the end of the radial neck. The acumed anatomic radial head prosthesis is designed to provide a precise anatomical implant to replace the patients native radial head. Radial head the radial neck is cut using a sagittal saw to create a flat surface perpendicular to the radial neck axis. The indication forfurther surgery, range of movement, mean mayo elbow. Radial head implant, or arthroplasty, was developed for the treatment of complex radial head fractures, and severe arthritic conditions causing radial head joint destruction. The smooth stem design continues to be utilized and is now supported by. Fashion removable longarm splint holding the elbow in 90 degrees. Silicone implants, first introduced in the late 1960s, have fallen out of favor because of high rates of implant fracture and silicone synovitis 9, 10. Using a microsagittal saw, resect any remaining radial head at the level of the radial neck, perpendicular to the axis of the. Alternative therapy for mason type 3 radial head fracture is radial head replacement. For radial head fractures that indicate joint replacement, this. The aim of the rhp is to replicate the physiological radiocapitellar tracking, reproducing the mechanical function of the native radial head. Bipolar radial head prosthesis with a smooth cementless stem effectively restores elbow. The mean age at operation was 54 years range 31 to 72 years.
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. Failure of early silicone implants via fragmentation21,23 led to the development of metallic prostheses. Radial head fracture explanation of procedure andor diagnosis anatomy the elbow joint is made up of three bones. Radial head fractures are fairly common 20% of all traumatic elbow injuries.
The anatomic radial head system is a comprehensive. The anatomic radial head system is a comprehensive solution for radial head fractures. Splint to be worn full time except for when performing therapy exercises for the rst 6 weeks. Nonoperative treatment is indicated in nondisplaced fractures, and direct stable. Radial head replacement is frequently used in treatment of radial head fractures or sequela. Radial head implant arthroplasty is a consideration for the treatment of comminuted, unreconstructable fractures of the radial head.
This is the knobby end of the radius, the bone on the thumb side of the lower arm. The radial head resection guide has two resection levels. Longterm outcomes of modular metal prosthesis replacement. Radial head prosthesis surgical technique depuy synthes 3. Radial head prostheses of today are considerably more effective than in the past, especially with use of metal implants and when used in an acute setting. Radial head prosthesis, radial head fractures,humeroradial posttraumatic arthritis, radial head replacement,elbow stiffness created date. Patients and methods we treated 11 patients with a bipolar radial head prosthesis because of elbow instability after previous treatment for masonjohnston type iii or iv radial head fractures. 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.
The lower end of the arm bone humerus joins with the two bones that form the forearm radius and ulna. When radial head excision is the definitive treatment, the radial neck is planed to a smooth contour that allows for placement of the prosthesis or. The device consists of a head that replaces the natural radial head and a stem that is inserted into the radius. Silicone prostheses have with radial head fractures and fracturedislocations. Patients synovectomy and radial head replacement with a silas tic prosthesis was carried out on 18 elbows between 1975 and 1979. The authors describe their case studies and results on the implantation of various radial head prostheses. The method may additionally include inserting a connection portion of the articulation component into a. Pdf vitallium radial head prosthesis for acute and chronic. Explor modular radial head surgical technique zimmer biomet.
Select a trial head that appears to correctly fill the gap. Pdf primary replacement of the fractured radial head with a. The depuy synthes radial head prosthesis system is designed to replace the arms natural radial head. Evolve proline modular radial head system wright medical group. The acutrak 2 mini system can be included in the base of the tray,as well as the mayo clinic radial head plate if needed upon request. Radial head prosthesis after radial head and neck fractures. Jun 01, 2018 background 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. A method for assembling a prosthesis system for replacement of a head portion of a proximal radius is provided and may include coupling an articulation component to a head component via a first locking portion of the articulation component and a second locking portion of the head component. Radial head prostheses rhp have been developed to decrease the complications rate following a radial head resection surgery. Outcomes of pressfit radial head arthroplasty following.
Bipolar radial head prosthesis with a smooth cementless stem effectively restores elbow sta bility and function after comminuted radial head fractures with or without concomitant elbow instability. The concept of radial head prosthetic replacement has gone through an evolution. Studies included patients with radial head fractures. Failure of a unipolar radial head prosthesis due to. It is the policy of health plans affiliated with centene corporation that radial head implants are medically necessary when meeting the following.
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. The other complications reported with radial head prosthesis are painful loosening, instability, neurological injury, cartilage damage, radial head disassembly and osteoarthritis 12. Radius head prosthesis an overview sciencedirect topics. One third of fractures involving the elbow joint affect the. The first radial head replacement system with colorcoded. Radial head prosthesis surgical technique depuy synthes trauma 7 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. Inspection of the radial head and trauma to the neck will determine if the standard or long collar radial stem implant will be used.
Wright medical evolve radial head faculty washington. Keywords radial head arthroplasty mason iii fractures implant biomecbanics history. For example, a size 5 stem will utilize a size 5 reamer with. Review article radial head replacement in adults with recent fractures. Radial head arthroplasty rha may be used in the treatment of nonreconstructable. Radial head arthroplasty has shown good results thus far in the. 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. Experience has demonstrated the silastic radial head to be only a temporizing spacer at best with tendency to compress under axial.
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. Outcomes of bipolar radial head prosthesis to treat complex radial head fractures in 22 patients with a mean followup of 50 months. Failure of a unipolar radial head prosthesis due to component. Radial head prosthesis please read these instructions for use, the synthes brochure important information and the corresponding surgical techniques carefully before use. Jan 25, 2018 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. Type 2 partial marginal fractures involving 2 mm of displacement are usually treated with open reduction and internal fixation. The results of this study suggest that the use of prostheses, if well positioned, is a valid solution in the treatment of secondary arthritis and fractures of the radial head with poor prognosis, with good results in the reduction of pain, recovery of movement and improved quality of life. Many innovative design features are incorporated into the implant heads and stems, as well as the instrumentation to improve the surgical technique. Guide the trial head onto the trial stem by hand or using. Pdf radial head prosthesis after radial head and neck.
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. Indications the radial head prosthesis system is indicated for primary replacement of the radial head after. Patients and methods we treated 11 patients with a bipolar radial head prosthesis because of elbow instability after previous treatment for masonjohnston type iii or iv radial head. Using mason classification, type 1 nondisplaced partial fractures are usually treated nonoperatively.
L2l radial head is designed with a smooth stem to be implanted intentionally linetoline. Data on patient characteristics including age, gender, injury complexity. Dec 28, 2017 for excision of the radial head as definitive treatment or for radial head replacement, the fragments are removed and an oscillating saw is used to remove additional radial neck or other fragments. Experience has demonstrated the silastic radial head to be only a temporizing spacer at. Radial head prosthesis implants consist of uncemented fixation stems and radial heads. Many innovative design features are incorporated into the implant heads and stems, as well as the instrumentation to facilitate the surgical technique. Pdf radial head arthroplasty has joined the armamentarium of options for the treatment of complex radial head fractures, elbow instability. Patient education radial head fracture the core institute. Device description this device is a modular radial head prothesis designed for use without bone cement. We analyzed outcomes by indication and specific implant. Swanson developed a silastic replacement as a spacer following traumatic loss of the radial head. Using a microsagittal saw, resect any remaining radial head at the level of the radial. Ensure that you are familiar with the appropriate surgical technique. We report our experience with the judet crf ii radial head prosthesis.
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