Radial head replacement of elbow

Radial head replacement surgery is undertaken on a patient’s elbow following a complex fracture to the radial head where fixation by means other than with screws or a plate is not suitable or feasible. During surgery, the fractured bone and joint surface of the radius is removed and replaced with an artificial implant. Ligament damage surrounding the elbow, commonly associated with an injured radial dial, may also be repaired during the surgery.

 

Following surgery, patients will have an incision on the outer aspect of their elbow. It will be sutured closed and protected by a waterproof dressing. A back-slab plaster might also be present if the associated ligament injuries were significant.

The following is an xray of a patient who has had a radial head replacement.

Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

Rehabilitation of the radial head replacement is largely dependent on the associated ligament injuries and repairs. Generally, in the case of a complex fracture, the lateral ulnar collateral ligament (LUCL) is injured necessitating surgical repair. Successful recovery is dependent on these ligaments being well protected.

 

Post-operatively, a patient’s arm will be in a sling and, more often-than-not, a back-slab.  All dressings and bandages need to remain intact and dry until the next post-operative review. In the meantime, patients can be advised to shower using a plastic bag tied above their elbow to prevent the wound from getting wet. Alternatively, a one-handed bath can be suggested to patients at least until Kemble has reviewed the wound and assessed that it is safe to resume normal showering or bathing.

 

The artificial radial head should be protected at all times in order for it to integrate successfully with the bone. A patient is therefore limited to the weight-bearing of “cup of tea” for the initial six weeks. Following this period, it is recommended patients bear no more weight than 5kg on the elbow for a further six months post-operatively.

 

Initial Phase (0-4 weeks)

Initial appointment (10-14 days post-operatively)

  • Remove post-operative dressing and primary dressing of wound

  • Apply tubigrip (or similar) to elbow to reduce post-operative swelling

  • Commence scar management if suitable

  • Commence overhead elbow protocol (in supine) consisting of active

    • elbow flexion and extension (in pronation)

    • forearm rotation (with elbow flexed 90 degrees) and

    • wrist extension and flexion

  • Continue with sling full-time except for hygiene and exercises.

  • (OPTIONAL – combine with hinged elbow brace limited to 30 degrees extension, dependent on surgeon preference)

  • Elbow Varus Precautions:

    • avoid shoulder abduction and internal rotation

    • avoid full elbow extension combined with forearm supination

    • when sleeping a pillow is placed between the affected arm and torso (when lying on back) or several pillows placed under elbow when side lying (on opposite side)

 

  • if excessive pain or unexpected stiffness in motion – suggest xrays to check for subluxation of joint

 

Intermediate Phase

 

Review Appointment (4 -6 weeks post-operatively)

  • Commence active elbow flexion and extension (including gravity assisted) with forearm in neutral and/or pronated position during elbow extension phase in a seated or standing position.

  • Commenced active and gentle passive forearm rotation in a seated or standing position with the elbow flexed. Avoid forced forearm supination

  • Continue with elbow varus precautions

  • Cease sling (and hinged elbow brace if previously fitted)

  • No functional use of arm permitted during this period.

 

Review Appointment (6-8 weeks post-operatively)

  1. Commence passive elbow flexion and extension exercises in both pronation and supination

  2. Cease elbow varus precautions at 8 weeks

  3. Commence light functional activity (up to 3 kgs maximum lift or weightbearing)

 

Advanced Phase

Review Appointment (8-12 weeks post-operatively)

  • Commence strengthening and conditioning exercises of the elbow, forearm and wrist

  • Commence ROM restoration splinting or strapping (dynamic or static progressive) for restricted elbow flexion or extension

  • Commence gentle weightbearing conditioning exercises

 

Return to activity / sports:

  • The rate of healing and the readiness of a patient to return to sport or normal activities, differs from one to another.  It is also highly dependent on a therapist's input.

  • Bone healing is determined via X-ray and Kemble will advise when sufficient healing as occurred for a patient to be able to return to specified activities. Most commonly, this occurs 12 weeks post operatively. However, factors such as age and general health an impact on this timeline.

  • Once the bone has healed sufficiently, therapists can encourage patients to increase weight-bearing through the arm and gradually return to sports.

 

Signs to look for:

  • Continued drainage from the wounds that does not stop after one week;

  • Sudden deterioration in a patient’s pain level when previously it had been improving;

  • Sudden locking of the elbow and inability to bend/straighten or rotate the forearm;

  • If any of the above is noted, please contact Kemble's team immediately.

 

General post-operative things to be aware of:

  • It is normal to have some tingling, numbness or weakness following the procedure. This is often due to a nerve block performed pre-operatively to help with pain management or associated with a local anaesthesia which is injected postoperatively. This should wear off in a day or two.

Possible Complications:

  • Early subluxation of radial head/elbow joint (posterolateral rotatory instability)

  • Elbow flexion contracture (capsular tightness of anterior capsule, or posterior/lateral bony block)

  • Elbow extension contracture (triceps tightness and/or posterior capsule, or anterior bony block)

  • late posterolateral rotatory instability

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for specific advice from either Kemble Wang or your other healthcare practitioners