Irreparable Radial Head Research Articles

A Unique Approach to Irreparable Radial Head Fracture Using an Osteochondral Plug: A Case Report.

An 18-year-old male patient sustained a traumatic injury that resulted in the loss of approximately 50% of the radial head. Subsequently, reconstruction was performed by transplanting an osteochondral plug harvested from the lateral femoral condyle. At the 1-year postoperative follow-up, the patient was pain-free and had a good range of motion. Using a novel technique, an irreparable radial head fracture was reconstructed using an osteochondral plug from the lateral femoral condyle. Reconstruction with osteochondral plugs may be a treatment option for partial loss of the radial head.

Radial Head Arthroplasty among Patients with Radial Head Fracture in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Proximal radial fractures are a common type of fracture around the elbow joint. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring the stability of the elbow joint and starting early mobilization. The aim of this study was to find out the prevalence of radial head arthroplasty among patients with radial head fracture in a tertiary care centre. A descriptive cross-sectional study was conducted from 25 January 2019 to 25 December 2020 among patients with a radial head fracture at the Department of Orthopaedics of a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee (Reference number: 076/77-08A). A convenience sampling method was used. The study group consisted of patients between 20 to 60 years of age with isolated radial head fractures. Radial head arthroplasty was done for Mason types III and IV fractures and functional outcome was calculated postoperatively with Mayo elbow score on follow-up at 3-, 6- and 12-month intervals. Point estimate and 95% Confidence Interval were calculated. Out of 96 patients with radial head fracture, 22 (22.92%) (17.59-28.25, 95% Confidence Interval) underwent radial head arthroplasty. The mean Mayo elbow score was 96.33±7.74 at 12 months of follow-up. The prevalence of radial head arthroplasty among irreparable radial head fractures was similar compared to other studies done in a similar setting. arthroplasty; elbow prosthesis; radius fractures.

Clinical and radiological outcomes of autologous humeral bone grafting for radial head reconstruction: a minimum 2-year follow-up.

The aim of this prospective study was to assess the clinical and functional results of radial head reconstruction with an autologous bone graft from distal humerus in 12 patients, with a follow-up for a period of 24months. From March 2017 to June 2018, we surgically treated 12 patients using an autologous bone graft from the lateral distal metaphysis of the homolateral humerus. Patients were divided into two groups: -Group A consisted of patients with previous failed ORIF for radial head fracture. Patients underwent revision surgery at an average time of 7months (between 6 to 8months) from the first surgery. All the patients reported pain during the elbow range of motion with no gross clinical signs or instability of the joint. They all presented standard X-ray and CT-scan of the elbow suggestive of non-union fracture. None of them presented osteoarthritic modification at the time of surgery. -Group B consisted of patients reporting acute irreparable radial head fractures. Patients were evaluated clinically at 6-, 12-, and 24-months duration according to Disabilities of the Arm. Shoulder and Hand (DASH), Mayo Elbow Performance Score (MEPS), and Visual analogue score for pain (VAS);, range of motion (ROM) was evaluated at 6 and 24months after surgery. Plain radiographs on anteroposterior and lateral views of the elbow were evaluated at final follow-up. In both, groups (A and B) patients showed a significant improvement with regards to VAS, MEPS, and DASH at each follow-up (p < 0.05). X-rays showed complete bone healing in all patients with no sign of mobilisation or loosening of the screws. One case in group A presented asymptomatic partial ossification of LUCL. No cases of fracture or residual pain at the donor site. Furthermore, no other complications such as infection, wound issues, elbow instability, elbow stiffness, ulnar neuritis, graft non-union were reported. Distal humerus bone graft should be considered a reliable option for the treatment of acute fractures that are unrepairable fractures or revision surgery for failed ORIF of the radial head, especially among young patients where prosthesis may be reserved as a salvage procedure, and radial head resection is a damaging and is not considered desirable. Level IV - Prospective Case Series.

Precision of computed tomography and cartilage-reproducing image reconstruction method in generating digital model for potential use in 3D printing of patient-specific radial head prosthesis: a human cadaver study

BackgroundA prosthetic replacement is a standard treatment for an irreparable radial head fracture; however, the surface mismatch of the commercially available designs is concerned for the long-term cartilage wear. The patient-specific implant created from 3D printing technology could be favorable in replicating the normal anatomy and possibly reduce such sequela. Our study aimed to assess the precision of the computed tomography (CT) and cartilage-reproducing image reconstruction method (CIRM) in generating digital models for potentially use in manufacturing the patient-specific prosthesis from 3D printing.MethodsEight intact elbows (3 right and 5 left) from 7 formalin-embalmed cadavers (4 males and 3 females) with mean age of 83 years (range, 79–94 years) were used for this study. Computerized 3D models were generated from CT, and CIRM. The cartilage-reproducing image reconstruction method has compensated the cartilage profile based on the distance between the subchondral surfaces of the radial head and surrounding bones in CT images. The models of actual radial head geometry used as the gold standard was generated from CT arthrography (CTA). All models of each specimen were matched by registering the surface area of radial neck along with the tuberosity. The difference of head diameter, head thickness, and articular disc depth among three models was evaluated and analyzed by Friedman ANOVA and multiple comparison test using Bonferroni method for statistical correction. A p-value of less than 0.01 was considered statistically significant. The difference of overall 3D geometry was measured with the root mean square of adjacent point pairs.ResultsThe analysis displayed the difference of diameter, thickness, and disc depth across the models (p< 0.01). Pairwise comparisons revealed statistically significant difference of all parameters between CTA models and CT models (p< 0.01) whereas no difference was found between CTA models and CIRM models. The mean difference of overall 3D geometry between CTA models and CT models was 0.51±0.24 mm, and between CTA models and CIRM models was 0.24±0.10 mm.ConclusionsCIRM demonstrated encouraging results in reestablish the normal anatomy and could be potentially used in production process of 3D printed patient-specific radial head prosthesis.

Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

BackgroundRadial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.MethodsA retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of 9 years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.ResultsIn patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.ConclusionsWith an average of 9 years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

Acute radial head replacement with bipolar prostheses: midterm results

In irreparable radial head fractures, especially if primary stabilizers of the elbow are damaged, the prosthetic replacement prevents instability and stiffness. Concerns have arisen over the use of bipolar press-fit prostheses due to the frequent finding of osteolysis and the risk of instability if compared to monopolar implants. Our aim was to assess midterm clinical and radiological outcomes of bipolar implants and the influence of osteolysis on proximal pain. Seventeen patients with irreparable fractures of the radial head, treated in acute with the same prosthetic model (rHEAD recon SBI/Stryker) between January 2015 and December 2018, were enrolled. Clinical assessment was performed using MEPS and DASH scores; a radiographic study was done to identify heterotopic ossifications and periprosthetic osteolysis. Outcomes at the last follow-up, according to MEPS, were excellent in 10 cases, good in 5 and fair in 2; none of the patients had severe pain or instability. In 3 cases, it was necessary to remove the implant, mainly because of early loosening. Radiological findings of osteolysis were detected in 9 cases, but no statistical correlation was found with MEPS and proximal pain. The use of bipolar implants is reliable if an accurate repair of ligament tears is performed and provides a good stability. Nevertheless, the risk of early aseptic loosening in uncemented implants is not negligible, and the follow-up of the patient must be strict. Late osteolysis does not seem to have clinical relevance, but further prospective studies are necessary to clarify this topic.

The Patient-Specific Implant Created with 3D Printing Technology in Treatment of the Irreparable Radial Head in Chronic Persistent Elbow Instability

Successful treatment of the chronic persistent elbow instability is a challenge for orthopedic surgeons. In this form, it is important to recognize and restore the osseous stabilizer in order to obtain the concentric reduction. In the present report, we describe a case of such injury with irreparable radial head treated with patient-specific radial head prosthesis which was created with 3D printing technology. To our knowledge, this is the first report in clinical use of this kind of prosthesis for the radial head fracture. At a 24-month follow-up visit, the patient was satisfied with the functional outcomes. The Mayo Elbow Performance Index (MEPI) increased from 20 points at the preoperative day to 85 points, and the patient-based Disabilities of the Arm, Shoulder, and Hand (DASH) was reduced from 88.33 points to 28.33 points. Due to the favorable result, replacement of the radial head with the patient-specific implant could be a useful treatment for the irreparable radial head in chronic persistent elbow instability.

Long-term outcomes of modular metal prosthesis replacement in patients with irreparable radial head fractures

BackgroundThe purposes of this study were to investigate the long-term outcomes of radial head replacement and to analyze the relationship between functional outcomes and periprosthetic radiolucency.MethodsWe retrospectively reviewed 32 patients who underwent unilateral radial head replacement between 2004 and 2011. Data on patient characteristics including age, gender, injury complexity, associated trauma, injury chronicity, and number of surgeries were collected and analyzed. Of these patients, 14 had terrible triad injury, 14 valgus-type injuries, 3 Monteggia fracture, and 1 concomitant distal humerus fracture. Clinical survey was performed at 7 to 15 years after replacement surgery. The Mayo Elbow Performance Score (MEPS) and shortened Disabilities of the Arm, Shoulder, and Hand (quickDASH) score were used for functional evaluation. Residual elbow or forearm pain was evaluated using visual analog scale (VAS). Radiographs were reviewed by orthopedic and radiologic specialists, and periprosthetic radiolucency was measured based on the diameter of radial head prosthesis.ResultsThe 32 patients returned for follow-up at an average of 8.94 years. None underwent prosthesis revision or removal. MEPS averaged 83.4; good or excellent results were achieved in 26 patients. QuickDASH scores averaged 11.7. Significantly better MEPS (p = 0.023) and quickDASH scores (p = 0.026) were noted when replacement surgery served as the primary surgery instead of late salvage. VAS scores averaged 1.25, with residual pain noted in 24 elbows (75%). Periprosthetic radiolucency was noted in 21 patients (66%) with a mean thickness of 3.53 mm. The difference in functional outcomes was not significant between patients with and without radiolucency, with p values of 0.127 for MEPS and 0.135 for quickDASH scores. Spearman correlation analysis showed low correlation between the measured width of radiolucency and VAS scores (r = 0.143).ConclusionSustained, encouraging clinical outcomes were reported in the present study. Although periprosthetic radiolucency did not correlate with functional or pain scores, surgical optimization and meticulous survey were warranted.

Midterm outcome of partial radial head replacement with a contoured iliac crest bone graft in complex elbow dislocation.

To report the midterm outcome of a novel reconstructive technique using a contoured iliac crest bone graft for partial radial head replacement in the treatment of complex elbow dislocation. Between January 2008 and December 2013, 10 patients (5 women, 5 men; mean age, 43.8 years; mean follow-up duration, 65.9 months) with complex elbow dislocation who underwent the partial radial head replacement with the contoured bone graft were included in the study. The irreparable radial head defects averaged 49% of the articular surface (range, 36-60%). The fracture involved the entire head in four patients and partial head in six patients. At the final follow-up, the mean elbow extension was 8°, flexion 143°, supination 76.5°, and pronation 73°. The mean Mayo elbow performance index was 93.2 points and the Broberg-Morrey functional rating score was 94.1 points, with seven excellent cases, two good cases, and one fair case. Radiographic union was achieved in all but one, at an average time of 6.89 weeks (range, 6-10 weeks). The final radiographs demonstrated no evidence of degenerative change in eight patients, mild arthritis in one patient, and moderate arthritis in one patient. This technique is a viable option in the treatment of the large radial head defect in complex elbow dislocation when more than 40% of the original head is still available for incorporation.

Functional outcome of radial head replacement in isolated radial head fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Proximal radial fractures are common type of fracture around the elbow joint. These commonly occur after an episode of fall on the outstretched arm. These fractures can occur in isolation or with other associated injuries. Among these comminuted radial head fractures are commonly associated with secondary injuries and instability of the elbow joint. Management of the radial head in such cases is very important in restoring stability of the elbow joint and starting early mobilization. This study will assess functional outcome of radial head replacement in isolated radial head fractures using Mayo elbow performance score&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Over a period of 24 months a total of 18 patients (male 12 and female 6) with isolated radial head fractures were included in the study. All of these patients had MASON type III fractures or above. Radial head replacement arthroplasty was done for irreparable radial head fractures and early mobilization was started. Functional outcome was calculated postoperatively with help of the Mayo elbow score on follow-up at 1, 3 and 6 month interval.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; On the basis of Mayo elbow performance scores, 13 patients had excellent results; 3 had good results; and 2 had fair results. Mean Mayo elbow score was 88.33 (SD 11.11) after 6 month follow up. None of the patients had elbow instability after radial head replacement&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Treatment of irreparable radial head fractures with radial head prosthesis along with soft-tissue reconstruction shows satisfactory results. Early mobilization of the elbow after operation is the key for restoration of elbow range of motion and function&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Anconeus interposition arthroplasty in acute multiligamentous elbow injuries with irreparable radial head fractures: a novel approach.

The purpose of this study was to evaluate the results of a new reconstruction with anconeus interposition arthroplasty in acute multiligamentous elbow injuries with irreparable radial head fractures. Five patients (3 males, 2 females) with a mean age of 42.6 years who underwent reconstruction with anconeus arhtroplasty were evaluated. With lateral approach, lateral capsuloligamentous structures were repaired, the radial head was excised, and anconeus interposition arthroplasty was performed. With medial intervention, the medial collateral ligament was repaired, and the ulnar nerve was transposed anteriorly. Clinical and radiological evaluation was performed the end of a mean follow-up period of 63 months. Mean Mayo Elbow Performance, Oxford Elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were 91, 41.4, and 13.76, respectively. Average elbow extension loss was 10.2° and average forearm supination loss was 5.2°. Dynamic elbow instability tests were within normal limits. On elbow radiographs, the average increase in cubitus valgus angle was 5.4°. No patient reported limitation in daily activities. There was no heterotopic ossification in any patient. Mean radial shortening was 1.39 mm, and no patient suffered from wrist pain at final follow-up. Average Mayo wrist score was 91 points. The combination of repair of the medial and lateral structures, radial head resection, and anconeus interposition arthroplasty may be a good alternative in the treatment of acute multiligamentous elbow injuries with irreparable radial head fracture.

Elbow dislocation with irreparable fracture radial head

Background:Treatment of elbow dislocation with irreparable radial head fracture needs replacement of radial head to achieve stability of elbow. An alternate method in cases of elbow dislocation with radial head fracture can be resection of radial head with repair of medial collateral ligament. We report a retrospective analysis of cases of elbow dislocation with irreparable radial head treated by excision head of radius and repair of MCL.Materials and Methods:Nine patients of elbow dislocation with associated irreparable fractures of the head of the radius were included in this analysis (6 F:3 M, Age: 35-47 years). Radial head excision was done through the lateral approach and MCL was sutured using no 3 Ethibond using medial approach. Above elbow plaster was given for 6 weeks and gradual mobilization was done thereafter. All patients were assessed at final followup using Mayo elbow performance score (MEPS).Results:Mean followup was 19.55 ± 7.12 months (range 14-36 months). There was no extension deficit when compared to opposite side with mean range of flexion of 138.8° ± 6.97° (range 130 -145°). Mean pronation was 87.7° ± 4.4° (range 80-90°) and mean supination was 87.7 ± 4.62° (range 80-90°). The mean MEPS was 98.8 ± 3.33 (range 90-100). No patient had pain, sensory complaints, subluxation or redislocation. All were able to carry out their daily activities without disability.Conclusion:Radial head excision with MCL repair is an acceptable option for treatment of patients with elbow dislocation and irreparable radial head fracture.

Delayed valgus instability and proximal migration of the radius after radial head prosthesis failure

Radial head resection has yielded excellent long-term results in isolated radial head fractures. Most comminuted radial head fractures are complicated by associated lesions, however, and acute radial head replacement is often indicated in these patients. Metal radial head prostheses have become the standard treatment of irreparable radial head fractures with associated lesions to the elbow or forearm that render the elbow or forearm unstable. The prosthesis has been postulated to act as a temporary spacer while the injured soft tissues heal. Subsequent removal of the prosthesis to decrease pain and increase mobility yielded good to excellent results in previously reported cases. However, we present a patient whose in whom the soft tissues did not heal over a prolonged period, leading to a poor result after removal of a radial head implant.

Management of Mason Type-III Radial Head Fractures with a Titanium Prosthesis, Ligament Repair, and Early Mobilization

Radial head fractures often occur in association with other elbow fractures and soft-tissue injuries. Radial head replacement is indicated for irreparable radial head fractures associated with elbow instability. The purpose of this study was to analyze the results after treatment of such injuries with a titanium radial head prosthesis, repair of torn collateral ligaments, and early mobilization of the elbow. Sixteen patients with sixteen Mason type-III radial head fractures and collateral ligament injury were treated with use of a titanium radial head prosthesis over a five-year period at the Royal Adelaide Hospital and Modbury Public Hospital in South Australia. The surgery was performed acutely in ten patients and was delayed an average of thirty-seven days (range, fifteen to seventy-nine days) in six. All patients were followed clinically and radiographically for a mean of 2.8 years (range, 1.2 to 4.3 years). Eight patients had an excellent result; five, a good result; and three, a fair result, according to the Mayo Elbow Performance Score. The three fair results occurred in patients with delayed surgery. The mean flexion contracture was 15 degrees (range, 0 degrees to 42 degrees ), with an average loss of 10 degrees (range, 0 degrees to 25 degrees ) of full flexion compared with that of the contralateral elbow. Both pronation and supination decreased an average of 12 degrees (range, 0 degrees to 45 degrees ) compared with that of the contralateral forearm. The results of treatment of Mason type-III radial head fractures with a monoblock titanium radial head prosthesis and soft-tissue reconstruction are satisfactory. Early mobilization of the elbow is important for the restoration of elbow range of motion and function.

Management of Mason Type-III Radial Head Fractures with a Titanium Prosthesis, Ligament Repair, and Early Mobilization

BACKGROUND: Radial head fractures often occur in association with other elbow fractures and soft-tissue injuries. Radial head replacement is indicated for irreparable radial head fractures associated with elbow instability. The purpose of this study was to analyze the results after treatment of such injuries with a titanium radial head prosthesis, repair of torn collateral ligaments, and early mobilization of the elbow. MATERIALS: Sixteen patients with sixteen Mason type-III radial head fractures and collateral ligament injury were treated with use of a titanium radial head prosthesis over a five-year period at the Royal Adelaide Hospital and Modbury Public Hospital in South Australia. The surgery was performed acutely in ten patients and was delayed an average of thirty-seven days (range, fifteen to seventy-nine days) in six. All patients were followed clinically and radiographically for a mean of 2.8 years (range, 1.2 to 4.3 years). RESULTS: Eight patients had an excellent result; five, a good result; and three, a fair result, according to the Mayo Elbow Performance Score. The three fair results occurred in patients with delayed surgery. The mean flexion contracture was 15° (range, 0° to 42°), with an average loss of 10° (range, 0° to 25°) of full flexion compared with that of the contralateral elbow. Both pronation and supination decreased an average of 12° (range, 0° to 45°) compared with that of the contralateral forearm. CONCLUSIONS: The results of treatment of Mason type-III radial head fractures with a monoblock titanium radial head prosthesis and soft-tissue reconstruction are satisfactory. Early mobilization of the elbow is important for the restoration of elbow range of motion and function.

Management of Mason type-III radial head fractures with a titanium prosthesis, ligament repair, and early mobilization.

Radial head fractures often occur in association with other elbow fractures and soft-tissue injuries. Radial head replacement is indicated for irreparable radial head fractures associated with elbow instability. The purpose of this study was to analyze the results after treatment of such injuries with a titanium radial head prosthesis, repair of torn collateral ligaments, and early mobilization of the elbow. Sixteen patients with sixteen Mason type-III radial head fractures and collateral ligament injury were treated with use of a titanium radial head prosthesis over a five-year period at the Royal Adelaide Hospital and Modbury Public Hospital in South Australia. The surgery was performed acutely in ten patients and was delayed an average of thirty-seven days (range, fifteen to seventy-nine days) in six. All patients were followed clinically and radiographically for a mean of 2.8 years (range, 1.2 to 4.3 years). Eight patients had an excellent result; five, a good result; and three, a fair result, according to the Mayo Elbow Performance Score. The three fair results occurred in patients with delayed surgery. The mean flexion contracture was 15 degrees (range, 0 degrees to 42 degrees ), with an average loss of 10 degrees (range, 0 degrees to 25 degrees ) of full flexion compared with that of the contralateral elbow. Both pronation and supination decreased an average of 12 degrees (range, 0 degrees to 45 degrees ) compared with that of the contralateral forearm. The results of treatment of Mason type-III radial head fractures with a monoblock titanium radial head prosthesis and soft-tissue reconstruction are satisfactory. Early mobilization of the elbow is important for the restoration of elbow range of motion and function.

RECONSTRUCTION OF THE INTEROSSEOUS LIGAMENT OF THE FOREARM REDUCES LOAD ON THE RADIAL HEAD IN CADAVERS

Excision of the radial head after fracture may be complicated by longitudinal radio-ulnar instability (Essex-Lopresti lesion) if the forearm interosseous ligament has also been torn. In such cases proximal migration of the radius occurs, and ulnar impaction at the wrist and radiocapitellar contact at the elbow may impair function. Although metal radial head arthroplasties are now used for irreparable radial head fractures, the long-term clinical outcome may still be unsatisfactory because of excessive radiocapitellar load causing pain. Interosseous ligament reconstruction might improve outcome by restoring normal load transfer from the radius to ulna, but the biomechanical effect of reconstruction has not been reported. This study evaluated forearm load transfer following interosseous ligament reconstruction with an Achilles tendon allograft in a cadaveric model with the radial head intact. Interosseous ligament reconstruction reduced proximal radius loading by transferring force to the proximal ulna, but force transfer by the reconstruction was only half that by the intact ligament.

Reconstructive Strategies for Radioulnar Dissociation: A Biomechanical Study

Radial head fracture combined with disruption of the soft-tissue restraints to proximal radial migration is defined as radioulnar dissociation. This injury often involves irreparable radial head fracture. When excised, management has emphasized the use of silicone implants to prevent proximal migration. However, concerns regarding silicone use led to the search for reconstructive alternatives. The purpose of this study was to compare reconstructive methods for radioulnar dissociation. Biomechanical testing to measure radial displacements under physiologic loads was performed on fresh-frozen cadavers after radial head resection. The central interosseous membrane (IOM) was disrupted to simulate radioulnar dissociation. This was followed by an orderly reconstructive sequence including radial head replacement with both silicone and titanium implants as well as a newly described flexible IOM reconstruction. Calculated stiffness values were used for comparison. Silicone implants provided no statistical improvement in forearm stiffness compared with the disrupted membrane state. Significant improvements were achieved with titanium implants and flexible IOM reconstruction, which restored stiffness to 89% and 94% of normal, respectively. No statistical differences were identified between these successful methods. Titanium implants combined with flexible reconstruction increased stiffness to 145% of normal. Further doubt is cast on the role of silicone implants in the management of radioulnar dissociation. Titanium implants and flexible IOM reconstruction appear to be wiser reconstructive choices.