Avoiding articular breakthrough in screw fixation of radial head fractures

Robert Gray, MD; Nathan Hoekzema, MD; Francisco Rubio, MD; John Heifner, MD; Allicia Imada, MD; Natasha Dark, BS; Kelly Scott, MD; Deana Mercer, MD

JSES International (Jul 2022)

Avoiding articular breakthrough in screw fixation of radial head fractures

Robert Gray, MD,
Nathan Hoekzema, MD,
Francisco Rubio, MD,
John Heifner, MD,
Allicia Imada, MD,
Natasha Dark, BS,
Kelly Scott, MD,
Deana Mercer, MD

Affiliations

Robert Gray, MD: Northshore University Healthsystem, Chicago, IL, USA
Nathan Hoekzema, MD: Department of Orthopaedic Surgery, University of California-Fresno, Fresno, CA, USA
Francisco Rubio, MD: Miami Bone and Joint Institute, Miami, FL, USA
John Heifner, MD: St George's University School of Medicine, Great River, NY, USA
Allicia Imada, MD: Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA
Natasha Dark, BS: Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA
Kelly Scott, MD: Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA
Deana Mercer, MD: Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA; Corresponding author: Deana Mercer, MD, Department of Orthopaedics, The University of New Mexico, MCS10 5600, 1 University of New Mexico, Albuquerque, NM 87131, USA.

Journal volume & issue: Vol. 6, no. 4
pp. 704 – 708

Abstract

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Background: The radial head is anatomically complex, making fracture fixation challenging because of the difficult visualization of the articular surface. As a result, screw penetration into the radiocapitellar joint can often occur. To facilitate safe placement of screws tangential to the joint surface, we define an approximate and reliable distance from the articular rim of the radial head that can minimize the risk of articular breach. Methods: A Kirschner wire for cannulated drilling was placed tangential to the articular surface in 15 cadaveric proximal radii. The distance from the wire to the articular rim was measured 3 times. After insertion of a 3.5-mm compression screw, the radial head was divided in the coronal plane, bisecting the screw track, to visualize the cross section of the screw's position. Headless compression screws of 3.5 mm were placed the distance from the most proximal edge of the screw track to the radial head's articular surface was measured 3 times. Results: The average distance from the articular rim to the distal surface of the Kirschner wire was 5.1 mm. The average distance from the articular rim to the proximal edge of the cavity was 1.7 mm. The screw placement was subchondral and extra-articular in all cases. Conclusion: When fixing Mason type 2 articular radial head fractures with 3.5-mm headless compression screws placed tangential to the articular surface, maintaining a screw entry point about 5 mm distal to the articular surface of the radial head will minimize the possibility of articular screw breach. This position also places the screw into subchondral bone, providing the best bone quality for mechanical support.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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