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Radial Head Replacement Using Evolve Proline Modular Radial Head System (Wright Medical) surgical technique

Overview

Learn the Radial Head Replacement Using Evolve Proline Modular Radial Head System (Wright Medical) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Radial Head Replacement Using Evolve Proline Modular Radial Head System (Wright Medical) surgical procedure.

Radial head fractures are common (approximately 20% of acute elbow injuries) and occur as a result of a fall onto an outstretched hand with the elbow in extension and wrist in pronation. The force is transmitted as an axial load through the wrist and through the radial head. They are more common in females and peak in the 4th decade.

The classification of radial head fractures is based a description of radial head fractures by Mason, but later modified by Broberg & Morrey and Hotchkiss . The classification is as follows and can be used in the decision making about which fractures may benefit from replacement of the radial head :

Type I – Undisplaced or minimally displaced (<2mm) or marginal lip fracture with no mechanical block

Type II – Displaced (>2mm) or angulated fracture, with mechanical block, without severe comminution

Type III – Comminuted and displaced fracture, not amenable to fixation

Type IV – Radial head fracture with associated dislocation

It must be appreciated by those treating these fractures that  Radial head trauma can range from a simple, isolated fracture to complex fracture patterns with significant associated soft tissue components such as :

Lateral collateral ligament (LCL) injury. The most common association from axial loading in supination

Medial collateral ligament (MCL) injury .Occurring due to axial & valgus force

Combination LCL & MCL injuries. These are a higher energy and sit at the severe end of spectrum

Coronoid fractures. Occurring due to axial load in extension +/- dislocation

Fracture dislocation. These may result in “terrible triad” injuries of elbow dislocation, radial head fracture and coronoid fracture.

Essex-Lopresti injury. An associated distal radioulnar joint injury with rupture of the interosseous membrane

Radial head replacement is reserved for fractures that are significantly displaced, cause a mechanical block to motion or are not reconstructible. Other indications are discussed in the indications section following .There are various prostheses manufactured to replace the radial head.

The Evolve Proline Modular Radial Head System (Wright Medical Group) has several design features of note that recommend it. Firstly the prosthesis is modular so allows for variations in normal anatomy. The aim is restore the particular radial height and stability of the elbow joint in motion which requires this flexibility. Secondly the prosthesis utilises a spacer concept with a smooth stem that fits loosely into the radial neck. This allows motion at this level so that the prosthesis can conform with the articular surface throughout the range of movement.

Author: Mr Samuel Chan FRCS (Fr & Orth)

Institution: The Queen Elizabeth Hospital ,Birmingham ,UK.

Feedback

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
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  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
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    The pass mark is 75%.
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CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity

COURSE

Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.

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