Radial Head Excision 24130

radial head excision

radial head excision xray

elbow cross sectional anatomy

radial head excision

Radial head excision xray

radial head fracture classification

Elbow surgical approaches

synonyms:radial head excision, radial head fracture excision

Radial Head Excision CPT

Radial Head Excision Indications

  • Type III radial head fracture in stable elbow.
  • Radiocapitellar Arthritis

Radial Head Excision Contraindications

  • Type I radial head fracture
  • Medial collateral ligament disruptioin
  • Interosseous membrane disruption
  • Throwing athletes

Radial Head Excision Alternatives

  • Radial Head replacement
  • Radial head ORIF
  • Non-operative management

Radial Head Excision Planning / Special Considerations

  • Ensure DRUJ and interosseos membrane are intact an not Essex-Lopresti lesion exists.
  • Average proximal migration of radius after radial head resection is 1.9 mm (Morrey BF, JBJS 1979;61Am:63).

Radial Head Excision Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Irrigate.
  • Close in layers.

Radial Head Excision Complications

  • Decreased grip strength
  • Decreased supination and pronation strength
  • Wrist pain
  • Progressive valgus instability
  • Proximal migration of the radius
  • Infection
  • CRPS
  • DVT/PR
  • Risks of anesthesia including heart attack, stroke and death

Radial Head Excision Follow-up care

  • Post-op: Splint with forearm in supination or neutral. Start early active range of motion as soon as possible. Consider Indomethacin 75mg QD/NSAIDs for patients with complex dislocations for HOreduction.
  • 7-10 Days: Evaluate incision, remove stitches, Begin early active range of motion as soon as possible. Start physical therapy. Avoid flexion in pronation.
  • 6 Weeks: Consider static progressive nightime extension splinting if a flexion contracture is present 6 weeks after injury. 10° to 15° flexion contractures are not uncommon.
  • 3 Months: Progress with ROM. May take 6-12 months to regain ROM. Begin sport specific therapy.
  • 6 Months: May return to full activities provided patient is asymptomatic
  • 1Yr: Assess outcomes, repeat xrays.

Radial Head Excision Outcomes

  • 18 year follow-up. 46% no symptoms, 44% occasional elbow pain, 10% daily pain. Flexion (139° ± 11°, extension (–7° ), supination (77° ± 20°) (all p < 0.01). 73% had cysts, sclerosis, and osteophytes, but none had a reduced joint space. No differences between primary and delayed radial head excision. (Herbertsson P, JBJS 2004;86A:1925).

Radial Head Excision Review References

  • Advanced Reconstruction-Elbow, AAOS 2007
  • Rockwood and Green's Fractures in Adults 6th ed, 2006