Sequelae of injuries of the lateral compartment of the elbow Assessment and possible solutions

Radial head fractures seem the most common injury of the elbow, with a reported incidence of 30-44% of elbow injuries. Radial head replacement is mandatory if the IOL injury is documented. We determined the cutoff value of 5.5 mm in supination-extension and 9 mm in supination-flexion positions to quantify the lateral pull technique. Our study showed a negligible and less than 0.5% rate of osteoarthritis following nonoperative treatment of radial head fractures even with more than 2 mm step off. Rarely, a radiocapitellar prosthetic arthroplasty (RC PA) may be a solution for painful arthritis, which showed 100% survival over the mean follow-up of 35 months (12-88). Our systematic review revealed that the rate of the radial head prosthesis (RHP) removal or revision is 10%, with a mean follow-up of 38 months, which was not significantly affected by the type of prosthesis fixation (cemented, uncemented smooth stem, uncemented press-fit), material (metal, titanium, pyrocarbon), and design (short vs. long stem and monopolar vs. bipolar). The study of our patients demonstrated that the decision to remove a prosthesis is associated with a specific surgeon, but the prosthesis design was not independently associated with prosthesis removal. A cost-effective method in place of the metal RHP has been introduced with good results in 8 patients using antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement. We applied 3D reconstruction and printing to design a custom-made mold for the radial head prosthesis. The results were comparable to the routine prostheses over an 18-month follow-up.