You are here

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