OPEN REDUCTION AND INTERNAL FIXATION OF RADIAL HEAD FRACTURES

Indications

• Open reduction and internal fixation (ORIF) for radial head fractures is used to stabilize displaced radial head fractures (Mason Type II) (Table 4.1).

• Non-displaced fractures (Mason Type I) are managed with early motion. To facilitate immediate motion aspiration of the joint fluid (haematoma) is recommended. Comminutedanddisplaced fractures(Mason Type III and IV) are best treated with complete early excision.

Pre-operative planning

Clinical assessment

• Pain localized in the affected elbow.

• Obliterated contour of the skin in the intracondylar recess (‘soft spot’).

• Assess and document neurovascular status of the arm.

• Careful examination of ligament stability is mandatory.

Radiological assessment

• Anteroposterior (AP) radiograph, a lateral view and a radial head view of the affected elbow (Fig. 4.1). A CT scan is helpful to demonstrate the exact fracture geometry. In children or in unclear situations (e.g. previous injury) the contralateral side should be evaluated.

Operative treatment

Anaesthesia

• Regional and/or general anaesthesia.

• At induction, administer prophylactic antibiotics according to local hospital protocol (e.g. 3rd generation cephalosporin).

Table and equipment

• Small-fragment instrumentation set or Herbert screw set - ensure the availability of the complete set of small compression screws.

• Radiolucent armtable.

• Image intensifier. Check for adequate visualization in 2 planes prior to draping.

Table set up

• The instrumentation is set up on the side of the operation.

• Image intensifier is fromthe front side of the armtable.