The long-term results of resection of the radial head for the treatment of
a simple radial head fracture have been generally
satisfactory1-5.
However, some late complications, such as proximal migration of the radius,
can disable the patient and are difficult to treat. Proximal migration of the
radius is usually
asymptomatic3-5,
although wrist pain develops in a minority of
patients3-8.
The options for treatment are limited, and clinical studies have shown poor
and unreliable
results9,10.
Sowa et al. described a case in which a silicone radial head prosthesis was
implanted for the treatment of wrist
symptoms10.
Proximal migration of the radius progressed, and it was concluded that a more
rigid implant would be necessary. Sellman et al. reached a similar conclusion
after performing a biomechanical study of this
problem11.
We report the case of a patient who had early progressive erosion of the
capitellum after the insertion of a metal radial head prosthesis for the
treatment of wrist pain following radial head resection after trauma. This
complication has not been reported previously, to our knowledge. Our patient
was informed that data concerning the case would be submitted for
publication.
An eighteen-year-old woman underwent resection of the radial head after
sustaining an irreparable fracture of the right radial head. Progressive wrist
pain developed six months after the resection. Ulnar variance was +3 mm at
that time. In July 1998, forty-four months after the resection, a floating
radial head prosthesis (Tornier SA, Saint-Ismier, France) was implanted.
Preoperative radiographs showed mild degenerative changes of the elbow and
some valgus positioning of the ulnohumeral joint and mild osteopenia of the
capitellum (Figs. 1-A and 1-B).
Surgery was performed through a lateral approach. At that time, the articular
cartilage of the capitellum appeared normal on gross inspection. After
resection of the radial neck at the required level, a trial prosthesis was
inserted. A small prosthesis size was chosen, and the stem was cemented into
the medullary canal. There was some difficulty in reducing the assembled
radial head prosthesis into the radiohumeral joint. Postoperatively, the
patient reported that the wrist pain was greatly reduced. Immediate
postoperative radiographs (Fig.
2-A) showed no substantial change in the appearance of the
capitellum in comparison with that on the preoperative radiographs.
Radiographs made at sixteen months (Fig.
2-B) and fifty-seven months
(Fig. 2-C) showed that the
subchondral cortical end plate of the capitellum had undergone progressive
depression and sclerosis whereas the ulnar border of the capitellum had
maintained its normal height. At sixteen months, radiographs showed an
unchanged ulnar variance of +3 mm for the right wrist and 0 mm for the left.
At fifty-seven months, the ulnar variance remained essentially unchanged.
Clinically, the patient had no wrist pain, despite the lack of improvement in
terms of ulnar variance. However, moderate pain and decreased mobility of the
elbow were noted. According to the Mayo Elbow Performance
Index12, the
function of the right elbow was fair (70 of a possible 100 points) as a result
of moderate pain.