Radial head prosthesis after fracture of radial head with associated elbow instability.
BACKGROUND
Fractures of the radial head and associated elbow instability can be treated with operation with radial head prosthesis. In this study, we evaluate function 1-7 years after implantation and also function after removal of five prostheses.


METHODS
Eighteen patients with radial head fracture and associated elbow instability were evaluated 3.7 years (1-7) after implantation of a radial head prosthesis. Pain at rest and during activity was measured with a visual analogue scale (VAS). Test of stability and neurological examination was done manually as well as measurement of the range of motion, using a goniometer. Activity of daily living (ADL) was estimated using five questions where the answers were graded between 1 and 3. The patients were asked to grade their general satisfaction according to the following scale; very satisfied, satisfied, not satisfied, disappointed. Plain X-rays were taken and 14 patients agreed to have their elbow strength evaluated using the validated BTE work simulator.


RESULTS
Five prostheses had been extracted due to poor range of motion. All these patients improved after extraction. All elbows were stable. No patient with extracted prosthesis had VAS score >2. The mean extension defect for this group was 15 degrees (5-25) compared to the mean extension defect for the 13 patients with the prosthesis still in place 15 degrees (0-40). The highest VAS score for the patients with prosthesis was five but the mean as low as 0.8. In the whole group, 13 patients were pain free. ADL function was good in general. The X-rays of the prostheses, still in place, showed radiolucent lines in 7 of the 13 patients. In the whole group, there was a significant decrease in supination, flexion and extension strength (P<0.01, P<0.01, P<0.05).


CONCLUSIONS
Radial head prosthesis works as a spacer after fracture of the radial head and associated instability. If range of motion is much restricted post-operatively, the prosthesis can be removed with improved function as result.
Department of Orthopaedics, Karolinska University Hospital, SE-171, 76 Stockholm, Sweden. per.wretenberg@karolinska.se
Per
P
Wretenberg
Anne
A
Ericson
André
A
Stark
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D004551:Elbow Joint / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome