title: Is a silastic radial head still a reasonable option?
abstract: BACKGROUND
  The importance of the radial head to elbow function and stability is increasingly apparent. Although preservation of the native radial head is preferred, severely comminuted fractures may necessitate resection or arthroplasty. Silastic radial head arthroplasty has been condemned on the basis of several sporadic reports of silicone synovitis. However, problems of "overstuffing," cartilage wear, and motion loss are becoming apparent with metal prostheses, indicating this also is not an ideal solution. Thus, the choices remain controversial.
  
  
  OBJECTIVE
  We asked whether intact or reconstructed primary elbow stabilizers permit use of silastic radial head implants without fragmentation, failure, and silicone synovitis.
  
  
  METHODS
  We retrospectively reviewed 23 patients with unreconstructable radial head fractures who were treated with silastic radial head arthroplasty and concomitant repair and/or reconstruction of the medial ulnar collateral ligament and/or lateral ulnar collateral ligament. Analysis included range of motion, pain, stability, and radiographic assessments; Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; and Mayo Elbow Performance Score (MEPS). The minimum followup was 16 months (average, 69.6 months; range, 16-165 months).
  
  
  RESULTS
  At last followup, the mean elbow flexion was 145°, extension 11°, supination 80°, and pronation 83°. The mean MEPS score was 88.9. The mean DASH score was 11.8. There were eight reoperations, none resulting from failure of the radial head implants.
  
  
  CONCLUSIONS
  These results demonstrate silastic radial heads can be used with low complication rates and without evidence of synovitis when concomitant elbow ligament repair or reconstruction is performed.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, The Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Maghen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Leo
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Hsu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Hausman
mesh_terms: D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation*; D004129:Dimethylpolysiloxanes; D004185:Disability Evaluation; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D009519:New York City; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013585:Synovitis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon