Radial head fracture in the medial collateral ligament deficient elbow; biomechanical comparison of fixation, replacement and excision in human cadavers

• Published in: Injury Vol. 37; no. 9; pp. 849 - 853
• Main Authors: Charalambous, C.P., Stanley, J.K., Siddique, I., Powell, E., Ramamurthy, C., Gagey, O.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-09-2006; Elsevier
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Arthroplasty, Replacement - methods; Biological and medical sciences; Biomechanical Phenomena; Cadaver; Collateral Ligaments - injuries; Diseases of the osteoarticular system; Elbow Joint; Elbow laxity; Excision; Female; Fixation; Fracture Fixation - methods; Humans; Injuries of the limb. Injuries of the spine; Injuries of the nervous system and the skull. Diseases due to physical agents; Joint Instability - etiology; Joint Instability - physiopathology; Medical sciences; Middle Aged; Models, Biological; Osteotomy - methods; Radial head fracture; Radial head replacement; Radius Fractures - physiopathology; Radius Fractures - surgery; Traumas. Diseases due to physical agents; Radial head fracture; Fixation; Excision; Elbow laxity; Radial head replacement; Availability; Human; Ligament; Radius; Nervous system diseases; Implant; Craniocerebral; Radial head; Diseases of the osteoarticular system; Fracture; Varus; Recommendation; Treatment; Laxity; Anesthesia; Models; Head trauma; Elbow; Comparative study
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2006.04.125

A widely used clinical recommendation is that in the presence of medial collateral ligament injuries, two-part radial head fractures should be fixed rather than excising or replacing the radial head. Direct biomechanical data comparing fracture fixation, radial head replacement and excision in a human cadaveric elbow model, have not been previously described. Such comparison is clinically important as with the increasing availability of radial head implants and promising follow up results, the role of radial head replacement in fracture management may have to be redefined. In this study, five fresh cadaveric elbows had radial head fracture creation and medial collateral ligament division, fracture fixation, radial head replacement and excision. Valgus and varus laxity were determined using an electromagnetic tracking system. Radial head replacement leads to a similar valgus (
P
=
0.80) and varus (
P
=
0.28) laxity as compared to radial head fixation. Radial head excision resulted in a significantly greater valgus laxity as compared to radial head fixation (
P
=
0.02) or replacement (
P
=
0.03). Both radial head excision and replacement led to a greater varus laxity as compared to fixation. Our results suggest that in the elbow with medial collateral ligament injury and two-part radial head fracture, fixation is overall biomechanically superior as compared to replacement and excision.