Is an extension of the safe zone possible without jeopardizing the proximal radioulnar joint when performing a radial head plate osteosynthesis?

• Verfasst von: Ries, Christian [VerfasserIn]
• Verfasst von: Pfau, Doreen [VerfasserIn]
• Titel: Is an extension of the safe zone possible without jeopardizing the proximal radioulnar joint when performing a radial head plate osteosynthesis?
• Verf.angabe: Christian Ries, Marcel Müller, Kilian Wegmann, Doreen B. Pfau, Lars P. Müller, Klaus J. Burkhart
• E-Jahr: 2015
• Jahr: October 2015
• Umfang: 8 S.
• Fussnoten: Gesehen am 21.03.2018
• Titel Quelle: Enthalten in: Journal of shoulder and elbow surgery
• Ort Quelle: St. Louis, Mo. : Mosby, 1992
• Jahr Quelle: 2015
• Band/Heft Quelle: 24(2015), 10, Seite 1627-1634
• ISSN Quelle: 1532-6500
• DOI: doi:10.1016/j.jse.2015.03.010
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: fracture
• Sach-SW: plate osteosynthesis
• Sach-SW: Radial head
• Sach-SW: safe zone
• K10plus-PPN: 157130259X

Abstract

Background: Proximal radial fractures are common elbow injuries. Because of the fracture pattern, stability criteria, or plate configuration, a plate position outside the “safe zone” (SZ) may be required in some cases when performing a radial head plate osteosynthesis. We examined the gross anatomy of the radial head and analyzed different so-called low-profile and precontoured radial head and neck plates with respect to the SZ. Materials and methods: Macroscopic measurements of the radial head and neck of 22 formalin-fixed human cadaveric upper extremities were obtained. The SZ was determined by maximum forearm rotation. If the edge of a plate could be extended beyond the respective SZ boundary without jeopardizing the proximal radioulnar joint (PRUJ) in maximum forearm rotation, a new plate-specific SZ boundary was set. Results: The mean SZ was 133° (SD, 14°). Among the 5 plates studied, only the 2 radial neck designs allowed the anterior edge of the plate to partially pass the lesser sigmoid notch of the ulna and consequently afforded a significant extension of the SZ in maximum pronation. All 3 radial head designs had to remain within the SZ to avoid interference with the PRUJ. A safe plate position depends on individual plate dimensions, particularly the proximal plate width, and the diameter of the radial head. The smaller the head diameter, the more accurately a plate must be placed within the SZ. Conclusions: If an extension of the SZ in radial head plate osteosynthesis is not essential, we recommend respecting the SZ to minimize the possibility of interference with the PRUJ.