Fracture of the radial head with associated elbow dislocation: Results of treatment using a floating radial head prosthesis

Objectives: To assess elbow function, complications, and problems of radial head fractures associated with elbow dislocation receiving surgical treatm ent with a floating prosthesis. Design: Prospective clinical study. Setting: University Hospital, Orthopaedic Department, Sart Tilman, Liege, B elgium. Patients: Eleven consecutive adult patients were treated with a floating pr osthesis for acute radial head fractures associated with elbow dislocation from January 1994 to September 1996. Intervention: The floating radial head prosthesis (Tornier SA, Saint-Ismier , France) was used in all our patients. The implant is in two parts: a radi al head made of high-density polyethylene enclosed in a cobalt-chrome cup, which articulates in a semi-constrained manner with the spherical end of a cemented intramedullary stem. The implants were inserted within the first w eek following the injury (range 2 to 7 days). Three cases also required int ernal fixation of the coronoid process of the ulna; in one case plate fixat ion of an olecranon fracture was also performed. Main Outcome Measurements: Patients were assessed by physical examination, a functional rating index (Morrey et al.), and radiographs. The parameters evaluated were motion, stability, pain, and grip strength. Potential compli cations such as infection, prosthetic failure, or dislocation were investig ated. Results: The minimum follow-up time was two years (mean 32 months, range 24 to 56 months). Four patients were considered to have excellent results, fo ur patients were considered to have good results, two patients had fair res ults, and one patient had a poor result. There were no cases of infection, prosthetic failure, or dislocation. No patient required prosthetic revision . Conclusion: The basic principle of maintaining anatomic and physiologic rel ationships applies when deciding on treatment for radial head fractures wit h associated elbow dislocation. The loss of lateral osseous support will re nder the elbow grossly unstable. We believe that a floating prosthesis may be indicated in Mason Type III radial head fractures associated with elbow dislocation, especially in the presence of associated destabilizing fractur es. Well-controlled comparative randomized studies will be needed to deline ate the optimal treatment for a given situation.