Posterolateral Rotatory Instability Following Radial Head Excision: A Prospective Study

Introduction: Radial head fractures accounts to about 0.5 % of all skeletal trauma. Treatment of Masons type 2 and 3 radial head fracture by radial head Arthroplasty (RHA) has been gained much momentum in the recent past. The aim of this study is to evaluate the functional out come and incidence of postero lateral elbow instability after radial head excision in terms of elbow stability and functional outcome Material& Methods This is a retrospective-prospective study of patients who have undergone radial head excision between March 2006 to July 2011. Of the total 15 pts 12 were males with age ranging from 21 to 62 yrs. Two pts had mason type 4 remaining were mason type 3. Patients were assessed in the subsequent follow up and evaluated functionally utilizing Mayo elbow score and clinico radiological assessment was done in terms of pain, elbow stability measured by lateral pivot shift test, valgus stress test, radiological evaluation. Results Of the 15 pts evaluated 5 of them complained of pain or sense of instability. Pivot Lateral shift test was positive in 5 of the 15 cases, with an average Mayo elbow score of 93.3. Average arc of motion range from 5deg to 140 deg, pronation of 88 deg, supination of 86 deg. Radiologically increased ulno-humeral distance was seen in 1 patient. All the five patients with pivot lateral shift test positive belong to the 50 to 70 year age group. Conclusion Radial head fractures treated with radial head excision can lead to posterolateral rotator instability. Open reduction and internal fixation of radial head fracture and prosthetic replacement are the other options which can prevent these complications.