Efecto de la supresión de la cabeza radial y la artroplastia en el codo. (Ing.)

Daphne M. Beingessner, BMath, BSc, MSc, MD, FRCSC1, Cynthia E. Dunning, MSc, PhD, PEng2, Karen D. Gordon, BScEng, PhD2, James A. Johnson, PhD, PEng2 and Graham J.W. King, MD, MSc, FRCSC2
1 Harborview Medical Center, 325 9th Avenue, Box 359798, Seattle, WA 98104 2 Hand and Upper Limb Centre, St. Joseph's Healthcare London, 268 Grosvenor Street, London, Ontario, Canada, N6A 4L6.

Investigation performed at Hand and Upper Limb Centre, Lawson Health Research Institute, The University of Western Ontario, London, Ontario, Canada

Background:
Radial head fractures are common injuries. Comminuted radial head fractures often are treated with radial head excision with or without radial head arthroplasty. The purpose of the present study was to determine the effect of radial head excision and arthroplasty on the kinematics and stability of elbows with intact and disrupted ligaments. We hypothesized that elbow kinematics and stability would be (1) altered after radial head excision in elbows with intact and disrupted ligaments, (2) restored after radial head arthroplasty in elbows with intact ligaments, and (3) partially restored after radial head arthroplasty in elbows with disrupted ligaments.

Methods:
Eight cadaveric upper extremities were studied in an in vitro elbow simulator that employed computer-controlled actuators to govern tendon-loading. Testing was performed in stable, medial collateral ligament-deficient, and lateral collateral ligament-deficient elbows with the radial head intact, with the radial head excised, and after radial head arthroplasty. Valgus angulation and rotational kinematics were determined during passive and simulated active motion with the arm dependent. Maximum varus-valgus laxity was measured with the arm in a gravity-loaded position.

Results:
In specimens with intact ligaments, elbow kinematics were altered and varus-valgus laxity was increased after radial head excision and both were corrected after radial head arthroplasty. In specimens with disrupted ligaments, elbow kinematics were altered after radial head excision and were similar to those observed in specimens with a native radial head after radial head arthroplasty. Varus-valgus laxity was increased after ligament disruption and was further increased after radial head excision. Varus-valgus laxity was corrected after radial head arthroplasty and ligament repair; however, it was not corrected after radial head arthroplasty without ligament repair.

Conclusions:
Radial head excision causes altered elbow kinematics and increased laxity. The kinematics and laxity of stable elbows after radial head arthroplasty are similar to those of elbows with a native radial head. However, radial head arthroplasty alone may be insufficient for the treatment of complex fractures that are associated with damage to the collateral ligaments as arthroplasty alone does not restore stability to elbows with ligament injuries.

Clinical Relevance:
Kinematics are altered after radial head excision, even in elbows with intact ligaments, and additional clinical study is needed in order to determine the long-term effects of this instability. Radial head arthroplasty alone does not adequately restore stability to elbows that have a ligamentous injury, and concomitant repair of ligaments and muscular origins should be considered at the time of surgical repair.