Radial Head Replacement Surgery in Delhi, India

Diagnosing radial head fractures begins with a physical examination. The doctor will detect signs of a fracture more effectively than an X-ray. To formulate an effective treatment plan, doctors assess the size and severity of the fracture and displacement in the bone. Pressure may be applied to the joint to test the joint stability and surrounding tissues. Surgery can be avoided if the pieces of bone in the radial head remain intact.

Standard radiographic imaging of the elbow with anteroposterior and lateral projections with radial head-capitellum view (modified lateral view with the tube angled 45° towards the radial head, as described by Greenspan) helps in assessing the severity of the fracture.

A CT scan can provide better information about any concomitant lesions, displacement and comminution of the fracture that may not be evident on standard radiographs.

It is challenging for patients with destabilized injuries to stabilize the fragments with head replacement. Other contraindications of this surgery are:

• Patients with damage to the interosseous ligament of the forearm (>3mm translation with radius pull test)
• Cases of coronoid fracture
• MCL deficiency

Before scheduling an appointment for the surgery, inform the surgeons about existing medical conditions. A complete body examination and imaging tests assist the operating doctors in preparing an appropriate treatment plan.

Medical Evaluation

A thorough medical and physical evaluation is a must before any surgical procedure. A cardiologist must also evaluate patients with chronic medical conditions such as heart disease before the surgery.

Medications

It is essential to inform the treating orthopaedic surgeon about any ongoing medications since some medicines need to be stopped before the surgery begins like the following over-the-counter medicines may cause excessive bleeding and should be stopped two weeks before surgery:

• Non-steroidal anti-inflammatory medications or painkillers
• A few arthritis medications

The primary care doctor or cardiologist advises patients on blood thinners to stop taking these medications before surgery.

Radial head replacement surgery is complex and requires technical and surgical expertise. Specific complications that may follow post-operatively are:

• Bleeding from the surgical wound is very common and usually settles after two days.
• Pain: Pain is the most common symptom experienced after any surgery. It remains around the elbow for a few days. It can be managed by taking appropriate painkillers - these can be over-the-counter or prescribed.
• Bruising:It occurs around the joint and the scar. It tends to resolve within 2-3 weeks after surgery.
• Infection: Infection is rarely occurring. However, for prophylactic reasons, antibiotics are always prescribed.
• Nerve injury: rarely occurs.
• Numbness around the scar: Slight numbness adjacent to the scar is common but does not cause any functional problems.
• Instability: Dislocation of the joint is possible. A splint or sling therapy is given after surgery to protect the elbow.
• Stiffness: This may happen following injury and surgery. In most cases, it resolves once the movement of the elbow begins with the aid of physiotherapy.
• Heterotopic ossification: New bone formation may occur outside the joint and impede movements, leading to stiffness. The excess outgrowth may need to be removed surgically.
• Implant-related symptoms: This rarely happens. In case it does, surgical removal is advised.
• Other complications: Chest infection, Deep vein thrombosis, Pulmonary embolism, Myocardial infection are possible after surgery.

The surgical wound is given a waterproof dressing after the surgery. The dressing should not be fidgeted with for at least 14 days. The dressing should be replaced immediately with a waterproof bandage if removed for any reason. Physiotherapist consultation is a must before getting discharged from the hospital since they assist with exercises and care instructions for the treated elbow. A protective sling needs tobe worn around the elbow for four weeks, and intermittently movements of the elbow need to be performed within certain limits.

After four weeks, one may stop wearing the sling and move the elbow actively through a more excellent range than before. Driving may be resumed after 4-6 weeks of surgery. Muscle strengthening workouts are advised to practice after 8-10 weeks. Forceful arm use or lifting heavy objects must be avoided for at least three months. Outpatient physiotherapy can be arranged and be continued for the next 3-6 months for optimum recovery.

An appointment should be scheduled for a follow-up session about two weeks after the procedure. Scheduling follow-up appointments for at least 12 months after surgery or until a satisfactory recovery is achieved, is imperative.

Reviewed by Dr. Vikas Gupta, Director - Orthopaedics and Head - Hand & Shoulder Surgery Orthopaedics & Joint Replacement, Arthroscopy & Sports Injury on 11-Feb-2023.