Capitellar arthritis / erosion (van Riet RP, JBJS 2004 86A:1061).If cementing the final implant size should be 2mm smaller than the final broach size to ensure a proper cement mantle. Final components are press fit or cemented using standard technique.
#Cpt code for orif radial head fracture full
Trial components are placed and the elbow is placed through a full ROM including suppination / pronation ensuring proper size, alignment and varus-valgus stability. The rasp should be pointed toward the capitellum during rasping for proper alignment. Rasp radial canal until cortical resistance is felt. A malaligned radial osteotomy will cause abnormal tracking during ROM, pain, capitellar DJD etc. The radial osteotomy is the key to the procedure. Size of resection is depended on implant used and fracture configuration. Evenly resect the radial neck perpendicular to its axis 14mm from the capitellum. See manufactures technique for specific proximal radius preparation and radial head prosthesis implantation technique. Radial head fragments are removed and reconstructed on the back table to ensure all bone is removed from the joint. If release of the LCL / extensor origin is needed it should be taken off the lateral epicondyle. Incise capsule anterior to the LCL complex. ECU elevated exposing the capsule and lateral collateral ligament. Interval between the anconeus and extensor carpi ulnaris opened. Dissection distal to the radial neck is avoided. Exposure is performed with the forearm pronated to decrease risk of PIN injury. Consider posterior incision if there is a potential need for medial reconstruction. Kocher lateral incision centered over radial head. Prep and drape in standard sterile fashion. Normal elbow ROM: Flexion/extension=0-135, Suppination=90, Pronation=90. Supine position (with arm table, or arm can be brought across chest). Always err on side of placing a smaller implant avoid overstuffing the joint with an implant that is to long or to large. 
Ensure manufacture implants and instruments are available.Pre-operatively template component size based on xrays of the normal side.Radial Head Replacement Pre-op Planning / Special Considerations Radial head excision: may cause decreased grip strength, wrist pain, and progressive valgus instability.Radial Head Replacement Contraindications Failed radial head excison with proximal migration of the radius.Essex-Lopresti injury with unrepairable radial head fracture.Synonyms: radial head arthroplasty, radial head replacement
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