JBJS essential surgical techniques · 2017
Treatment of Radial Head Fractures with a Modular Metallic Radial Head Replacement.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Longstaffe Robert, King Graham J W, Marsh Jonathan P
Аннотация
INTRODUCTION: Radial head arthroplasty with a smooth-stemmed metallic modular implant is a reliable treatment option for patients with acute unreconstructible radial head fractures, and good clinical outcomes may be expected beyond 5 years of follow-up (Video 1).
STEP 1 PREOPERATIVE PLANNING: Obtain a careful history and perform a physical examination along with appropriate imaging to facilitate appropriate treatment decisions.
STEP 2 OPERATING ROOM SETUP AND PATIENT POSITIONING: Perform proper operating room setup and patient positioning, as they are required to gain access to all affected structures around the elbow in a safe and efficient manner.
STEP 3 APPROACH: Make a midline posterior skin incision with development of a full-thickness lateral fasciocutaneous flap or use a direct lateral incision; the deep interval is determined on the basis of the integrity of the LCL.
STEP 4 RADIAL HEAD EXCISION: Remove and preserve all fragments of the radial head for implant sizing.
STEP 5 IMPLANT SIZING: Implant a prosthesis that closely replicates the dimensions of the native radial head, which is the primary goal of the procedure.
STEP 6 STEM BROACHING: Sequentially broach the canal until good cortical contact is achieved and undersize the definitive stem by 1 mm to allow implant movement within the canal and appropriate articulation with the capitellum.
STEP 7 INSERTION OF TRIAL COMPONENTS AND FINAL RADIAL HEAD IMPLANT: With the selected trial in place, assess the radial head diameter, height, and articular congruency.
STEP 8 CLOSURE AND REPAIR OF THE LCL: Ensure proper repair of the LCL as it is essential to maintaining or restoring elbow stability.
STEP 9 POSTOPERATIVE PROTOCOL: Postoperative rehabilitation depends on the status of the collateral ligaments.
RESULTS: In a review of the cases of 55 patients at a mean follow-up of 8 years after radial head arthroplasty with a smooth-stemmed modular metallic prosthesis, Marsh et al.9.
STEP 1 PREOPERATIVE PLANNING: Obtain a careful history and perform a physical examination along with appropriate imaging to facilitate appropriate treatment decisions.
STEP 2 OPERATING ROOM SETUP AND PATIENT POSITIONING: Perform proper operating room setup and patient positioning, as they are required to gain access to all affected structures around the elbow in a safe and efficient manner.
STEP 3 APPROACH: Make a midline posterior skin incision with development of a full-thickness lateral fasciocutaneous flap or use a direct lateral incision; the deep interval is determined on the basis of the integrity of the LCL.
STEP 4 RADIAL HEAD EXCISION: Remove and preserve all fragments of the radial head for implant sizing.
STEP 5 IMPLANT SIZING: Implant a prosthesis that closely replicates the dimensions of the native radial head, which is the primary goal of the procedure.
STEP 6 STEM BROACHING: Sequentially broach the canal until good cortical contact is achieved and undersize the definitive stem by 1 mm to allow implant movement within the canal and appropriate articulation with the capitellum.
STEP 7 INSERTION OF TRIAL COMPONENTS AND FINAL RADIAL HEAD IMPLANT: With the selected trial in place, assess the radial head diameter, height, and articular congruency.
STEP 8 CLOSURE AND REPAIR OF THE LCL: Ensure proper repair of the LCL as it is essential to maintaining or restoring elbow stability.
STEP 9 POSTOPERATIVE PROTOCOL: Postoperative rehabilitation depends on the status of the collateral ligaments.
RESULTS: In a review of the cases of 55 patients at a mean follow-up of 8 years after radial head arthroplasty with a smooth-stemmed modular metallic prosthesis, Marsh et al.9.