Treatment protocols for radial head fractures. Radial head prosthesis.

Treatment protocols for radial head fractures have evolved over thelast fifteen years, especially with the development of miniosteosynthesisand radial head prosthesis. For non displaced fracture (MasonI), non surgical treatment is recommended by most of the authors.For partial displaced fractures (Mason II), open reduction and internalfixation, using mini-screws for instance, must be performedeach time the fixation allows early physical therapy. In these twofirst types of fractures, if physical therapy is started as soon as possible,results are usually excellent.For total and complex radial head fractures (Mason III and IV),excision of the radial head must be performed each time the fixationis not stable enough to allow early mobilization. Excision of theradial head has been advocated for treatment of displaced and comminutedfractures of the radial head or neck. Many complicationsoccur such as proximal migration of the radius, progressive valgusdeformity and late humero-ulnar joint degenerative arthritis. Toavoid such complications, Swanson in the early sixties recommendedits replacement by a silicone implant. But fracture of theimplants and siliconitis, true loco regional disease, is now wellidentified. From a biomechanical point of view, a manufacturedimplant from a harder material would be a better solution. TheGuepar radial head prosthesis is indicated in acute complete radialfractures which are not osteosynthesable. In the case of associatedligament lesions, the lateral column is stabilized. Results at midtermfollow-up are satisfactory regarding pain and range of motion. Itgives a better recovery of strength, especially in young patients.Finally, it prevents an evolution toward elbow instability and radiusascension.