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Chiropractic Journal of Australia : CJA December 2012
124 Chiropractic Journal of Australia Volume 42 Number 4 December 2012 Currently the patient is back at work part time; he has no neck pain but continues to modify his activities slightly due to his decreased strength and reduced ranges of motion in his right elbow. DISCUSSION There are several classifcations for radial head fractures, depending on the position, number of fracture fragments and the degree of radial disassociation.10 The orthopedic management of radial head fractures is dependent on the grade or severity of the radial head fracture, and ranges from casting for simple and stable fractures, to surgical procedures such as open reduction internal fxation (ORIF), radial head resection and radial head replacement (RHR) for more severe and unstable fractures.4,6,9,10,11 If severe radial head fractures are not managed properly, non union and dysfunction is expected, which will have a negative impact on the patient's quality of life. If surgery is required, it is preferable to initiate it as soon as possible at the time of injury.7,10,11 Of the current surgical options available for the repair of complex radial head fractures, short, mid and long term studies have shown that RHR with proper rehabilitation has good to excellent outcomes in patient pain levels, functionality and grip strength.8,11-13 In a long term follow up study of RHR done by Burkhart et al11 they followed a patient population of 17 patients post RHR, with an average follow up time of 8.8 years. The outcomes were excellent to good in 16 of the 17 patients.11 The outcomes are better if the surrounding soft tissues are intact and/or repaired to help support and stabilize the prosthetic joint.4,14 Complications, although rare, include acute complete dislocation of the prosthesis posteriorly off the capitulum, to minor alignment issues of the prosthetic head with the trochlea.11 Therefore the post operative rehabilitation and strengthening process of the upper extremity is critical to ensure an optimal outcome. Despite possible complications as a result of the RHR, the long term functional outcomes for patients with complex radial head fractures appear good to excellent.3,8,11-13 Figure 3: Sagittal CT slice showing fragmentation of the radial head with large anterior (arrow) and posterior fragments of the radial head (block arrow) Figure 4: Coronal CT slice showing the radial head fracture and fragmentation. The jagged remains of the proximal radius are directly articulating with the capitulum. Figure 5: AP and lateral post-operative plain flm elbow showing the radial head replacement (RHR) prosthesis. CASE DISCUSSION OF A RADIAL HEAD REPLACEMENT ONLAND • JIAN
CJA September 2012
CJA March 2013