Radial head

1. RADIAL HEAD FRACTURE FIXATION BY TRIPOD
TECHNIQUE

2. Type 1 = Minimally displaced (<2 mm) fracture,
Only marginal lip fracture,
No bony/mechanical limitation of movement.
Type 2 = Displaced (<2 mm) fracture,
More than a marginal lip fracture,
Movement is mechanically blocked, but no comminution.
Type 3 = Severely comminuted,excision mandatory.
Type 4 = Radial head fracture + subluxation of radio-humeral joint.
MASONS CLASSIFICATION OF RADIAL HEAD FRACTURES

3. MANAGEMENT OF FRACTURE ACCORDING TO TYPES :-
• Mason type I fractures - non surgically and conservatively.
• Mason type II & III fractures with 3 or fewer fragments - Open
reduction and internal fixation using 2 to 3 lag screws.
• Transverse radial neck involvement or axial instability required
the additional use of a mini fragment T-plate or locking proximal
radius plate.
• More recently, less invasive techniques such as the cross-screw
and tripod techniques(using headless compression screws) have
been proposed.

4. THE TRIPOD TECHNIQUE OF RADIAL HEAD FIXATION :-
• A quick, simple, and less invasive technique than plating,
• Buried nature of headless compression screws avoids interference
with the proximal radioulnar joint allows for fixation even outside of the
safe zone.
• The 3-screw approach also allows for more perpendicular
compression of transverse radial neck fractures than a 2-screw
approach.
• Several studies have shown screw-only approaches to be comparable
in strength and efficacy to traditional plate and screw fixation.

5. INDICATIONS & CONTRA-INDICATIONS
• The primary indication for the tripod technique is a Mason type II
radial head fracture,
• Transverse radial neck fractures (both articular fractures and extra-
articular)
• Mason type III fractures with 3 or fewer fragments & Mason type I
fractures with mechanical block on physical examination may also be
appropriate indications.
• Severe comminution with greater than 3 fragments is a
contraindication to ORIF and would be an indication for a radial head
Arthroplasty.

6. KA-I A-ECU-PIN
CAP

7. KW- RC-WR- NA
PH
3.5-HL-CAN-COM

8. • The appropriately sized cannulated screw is next inserted and
tightened until compression occurs, and the screw is sunk in the
near cortex below the chondral surface.
• This process is then repeated in varying degrees of prono-
supination so that up to 3 screws are distributed
circumferentially around the radial head, forming a tripod.

9. POSTOPERATIVE MANAGEMENT AND PITFALLS
• Early mobilization is the most important postoperative goal to prevent
contractures and the potential need for future surgical release.
• Full range of motion attained by 6 weeks
• The PIN can be protected by positioning the forearm in pronation throughout
the surgical approach,
• Avoiding anterior dissection over capsule to avoid injury to lateral collateral
ligamentous complex