engleski

Radial head arthroplasty after previously performed resection of the radial head

Radial head arthroplasty (RHA) is often used method in treatment of multifragmentar radial head fractures. Best results achives arthroplasty performed immediately after the fracture. In cases where radial head is irreparable, and there are no technical conditions for arthroplasty, resection of the radial head is available treatment option. With time, these patients develop different problems like: loss of strength, valgus instability and wrist pain due to proximal migration of the radius. Valgus deformity causes development of cubital tunnel syndrome. Elbow contracture occurs with time, manifesting in the form of a limited joint extension and flexion. Development of degenerative changes leads to the elbow pain appearance. In a one year period, in the Department of Orthopaedic Surgery in University Hospital Centre Zagreb we performed RHA in 5 patients in whom radial head excision, due to fracture, was already done. There were 3 male and 2 female patients, average age 51.2 years (from 44 to 57). RHA in these patients was associated with several problems. One of the problems we encountered was inability to perform the arthroplasty due to previous excessive resection of radial head. An additional problems were abundant scar tissue that caused elbow contracture and increased risk of interosseus posterior nerve injury due to changed anatomical relations. Preliminary treatment results showed a significant improvement in the functional status accompanied by marked reduction in symptoms in average follow up period of 11.2 months (from 3 to 15). Although RHA is conceptually attractive and sound in situations in which radial head excision is inadequate, clinical experience is still limited. Surgical treatment requires precise preoperative planning, while in the postoperative period a persistent and long-term implementation of adequate physical therapy with mandatory prophylaxis of heterotopic ossification are required.

radial head, arthroplasty, contracture, function

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