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.
- 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
- 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