Management of Mason Type-III Radial Head Fractures with a Titanium Prosthesis, Ligament Repair, and Early

Mobilization

by G.I. Bain, N. Ashwood, R. Baird, and R. Unni

J Bone Joint Surg AmVolume 87(1 suppl 1):136-147

March 1, 2005

©2005 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior and lateral radiographs showing a radial head fracture with an associated fracture of the coronoid process and an unstable elbow joint.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Algorithm for the management of acute traumatic elbow instability.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-A The global extensile approach to the elbow allows exposure of both collateral ligaments.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Clinical photograph of the global extensile approach to the elbow.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-A Following exposure of the lateral ulnar collateral ligament (LUCL), the capsule anterior to the ligament is incised with use of a z-shaped incision.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing a z-shaped incision.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

The anterior capsular flap, when released from the epicondyle, exposes the lateral side of the joint without violating the lateral ulnar collateral ligament (LUCL).

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Releasing the posterior capsular flap allows insertion of the metallic prosthesis but disrupts the lateral ulnar collateral ligament and therefore makes the elbow unstable.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Valgus stress test with the radial head excised.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

A Kocher clamp is placed on the radial neck, and the radius is axially loaded to assess the competence of the interosseous membrane.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Postoperative lateral radiograph of an elbow with the EVOLVE radial head prosthesis (Wright Medical Technology).

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-A Exposure of the medial portion of the joint.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Photograph showing exposure of the medial portion of the joint.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

Stability of the elbow.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

The lateral collateral ligament complex is stabilized with transosseous interrupted sutures, with the elbow held in 30° of flexion and the forearm in full pronation.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.

The dynamic elbow suspension splint elevates the extended elbow.

G.I. Bain et al. J Bone Joint Surg Am 2005;87:136-147

©2005 by The Journal of Bone and Joint Surgery, Inc.