Monopolar Radial Head Research Articles

Short- to midterm outcomes of 139 pyrocarbon monopolar radial head arthroplasties

The MoPyc radial head arthroplasty (RHA) is a monopolar implant with a pyrocarbon head that obtains rigid fixation via controlled expansion of the titanium stem. The aim of this study was to evaluate the short to midterm outcomes of MoPyc RHA. Between 2002 and 2021, 139 MoPyc RHA were implanted in 139 patients with a RH fracture. The mean follow-up was 5.9 years ±3.5 (range 1-16). Range of motion, mean Mayo Elbow Performance score (MEPS), quick disabilities of the Arm, Shoulder and Hand (quickDASH) score, visual analog scale (VAS), radiographic outcome, and reason for failure were recorded. The mean MEP, QuickDASH, and VAS scores were 89.1± 2.2(range, 45-100), 17.5±16.7(range, 0-78), and 0.8±1.6(range, 0-50), respectively. Stress shielding (SS) and osteolysis around the stem (OAS) were identified in 92(66%) and 20(14%) patients. A total of 47(29%) patients experienced at least one complication; and 29(21%) of them required re-intervention. Persistent stiffness (n=12;9%) was the most common complication. No painful loosening was noted. Osteolysis around the stem, presence of an autoexpanding stem, and overstuffing were associated with a lower MEPS and an increase in VAS (p<0.05). Stress shielding (SS) was associated with an increase in MEPS (aβ=6.92; p<0.001) and lower VAS (aβ=-0.69; p=0.016). The auto-expending stem increased the likelihood of SS after RHA (aOR=1.49; p=0.001). A well-fixed MoPyc RHA provided satisfactory short to midterm outcomes, without painful loosening. However, the autoexpanding stem system was associated with poorer functional outcomes and increased the likelihood of SS.

Radiographic and clinical comparisons between loose-fit and press-fit stems in monopolar radial head arthroplasty for comminuted radial head fractures

PurposeFew clinical studies have compared the operative outcomes between loose- and press-fit stems in radial head arthroplasty (RHA). We aimed to evaluate the radiographic and clinical results of the two radial head implant concepts. MethodsIn this retrospective multicenter study, 32 patients (24 women and 8 men) with a mean age of 63.1 years who underwent RHA for comminuted radial head fractures were reviewed between 2005 and 2021. Seventeen patients underwent RHA with a loose-fit stem (L-group), whereas the remaining fifteen patients underwent RHA with a press-fit stem (P-group). The mean follow-up period was 40.1 ± 9.9 months, with the minimum follow-up duration of 12 months. The radiographic findings were evaluated for periprosthetic osteolysis; furthermore, clinical outcomes were analyzed to measure the range of motion of the elbow. The rate of reoperations and prosthesis removal were also reviewed. ResultsThe general characteristics of the patients were similar in the two groups. The rate of periprosthetic osteolysis was 17.6% in the L-group, whereas it was 53.3% in the P-group. The mean elbow flexions were 128° and 133° in the L- and P-groups, respectively. The mean elbow extensions were −12° and −9° in the L- and P-groups, respectively. The rate of reoperation was 23.5% in the L-group and 15.2% in the P-group. One patient in the L-group had the prosthesis removed because of surgical site infection, whereas one patient in the P-group had the prosthesis removed owing to painful loosening. ConclusionsNo significant differences in the clinical outcomes and reoperation rate were observed between the two radial head implant concepts in this study. However, osteolysis occurred more frequently in the P-group. Although patients with periprosthetic osteolysis are currently asymptomatic, they should be carefully followed up for the symptoms in the long term.

The load transfer effect of monopolar and bipolar radial head prosthesis designs on capitellar cartilage: A comparative biomechanical cadaver study.

The aim of this study was to determine whether bipolar radial head arthroplasty may transfer less load to the capitellum than monopolar radial head arthroplasty and native radial heads. Six human elbow joints were obtained from six fresh frozen cadavers (3 males, 3 females; mean age = 78 years, age range = 66-80). None of the elbow joints had a previous osseous injury, a chondral defect, osteoarthritis, or instability. In group 1, load transfer of the native radial head was measured in each specimen under 100 N of compression force using a custom-made load cell at 0°, 30°, 60°, 90°, and 120° flexion of the elbow in supination, neutral rotation, and pronation, respectively. After excision of the radial heads, the same testing protocol was first applied for monopolar radial head arthroplasty (Group 2) and then for bipolar radial head arthroplasty (Group 3). The mean load transfer on the capitellum was significantly higher in each forearm rotation and all angles of the elbow flexion in the arthroplasty groups than the native radial head group. Mean load transfer values of bipolar prostheses were between the values of native radial heads and monopolar prostheses in all positions. Bipolar prostheses showed similar load transfer characteristics compared to those of the native radial head in supination at 60° flexion; in neutral rotation at 0°, 30°, 60°, and 120° flexion; and in pronation at 90° and 120° flexion. The results of this study have revealed that bipolar radial head arthroplasty transfers similar loading as the native radial head on the capitellum in certain forearm positions and at elbow flexion angles. No significant differences could be found between load transfer values of bipolar head design and monopolar head design except in the pronation at full extension.

Long-term outcome and survival rate of monopolar radial head replacement

The purposes of this study were 1) to report functional outcomes, 2) to assess complications, revisions and survival rate, and 3) to assess differences in functional outcomes between removed and retained RHAs, early and delayed treatment, and type of RHA used at long-term follow-up after monopolar RHA for unreconstructible radial head fractures or their sequelae. Seventy-eight patients (mean age 59.2 years) that were at least six years postoperatively following monopolar RHA between 1994 and 2010 for unreconstructible RHFs or their sequelae and were included. The Mayo Elbow Performance Score (MEPS), Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, the Visual Analog Scale (VAS), postoperative satisfaction (1-6, 6=highly unsatisfied), range of motion, complications and revisions were assessed. Radiographic findings were reported. Kaplan-Meier survival analysis was performed. Subgroups (RHA type, early vs. delayed surgery, RHA removed vs. retained) were compared. At a median clinical follow-up of 9.5 years (range: 6.0-28.4), median MEPS was 80.0 (IQR:60.0-97.5), median QuickDASH was 22.0 (IQR:4.6-42.6), median VAS was 1 (IQR:0-4), median postoperative satisfaction was 2 (IQR:1-3), and median arc of extension/flexion was 110° (IQR:80°-130°). Radiographic follow-up was available for 48 patients at a median of 7.0 years (range: 2.0-15.0). Heterotopic ossifications were seen in 14 (29.2%), moderate to severe capitellar osteopenia/abrasion in 3 (6.1%), moderate to severe ulnohumeral degeneration in 3 (6.1%) and periprosthetic radiolucencies in 17 (35.4%) patients. Twenty-nine patients (37.2%) had complications and 20 patients (25.6%) underwent RHA exchange or removal. Kaplan-Meier analysis with failure defined as RHA exchange or removal demonstrated survival of 75.1% (95% CI 63.7-83.3) at 18 years. The highest annual failure rate was observed in the first year in which the RHAs of seven patients (9%) were exchanged or removed. No significant differences were detected between type of RHA in MEPS (Mathys: 82.5 (75.0-100) vs. Evolve: 80.0 (60.0-95.0); P=.341) and QuickDASH (Mathys: 12.5 (0-34.4) vs. Evolve: 26.7 (6.9-46.2); P=.112). Early surgery (≤3weeks) yielded significantly superior MEPS (80.0 (70.0-100.0) vs. 52.5 (30.0-83.8); P=.014) and QuickDASH (18.6 (1.5-32.6) vs. 46.2 (31.5-75.6); P=.002) compared to delayed surgery (>3weeks). Patients with retained RHAs had significantly better MEPS (80.0 (67.5-100) vs. 70.0 (32.5-82.5); P=.016) and QuickDASH (18.1 (1.7-31.9) vs. (49.1 (22.1-73.8); P=.007) compared to patients with removed RHAs. Long-term outcomes for RHA are satisfactory; however, there is a high complication and revision rate, resulting in implant survival of 75.1% at 18 years with the highest annual failure rate observed in the first postoperative year. Level III; Retrospective Cohort Comparison; Treatment Study.

Mid-term clinical outcome comparison of long-stemmed monopolar osseointegrated and short-stemmed bipolar radial head prostheses

Comparative data to guide implant choice for radial head replacements are lacking. Here, we compared the clinical results achieved using two different types of radial head prostheses. Data from patients with comminuted radial head fractures (n = 66), who underwent radial head arthroplasty with either short-stemmed bipolar (n = 31, Group 1: rHead Small Bone Innovations/USA) or monopolar long-stemmed osseointegrated rigidly fixed (n = 35, Group 2: MoPyC Tornier/France) prostheses, were retrospectively reviewed. Patients were followed-up for an average of 42months (16-64months). Range of elbow motion, elbow stability, grip strength, and visual analog scale (VAS) pain were measured, and functional outcome assessed using the Mayo Elbow Performance Score, the Disability of Arm, Shoulder and Hand questionnaire, and the Broberg-Morrey Score. Complications were analyzed and revision surgeries recorded. Most patients achieved good/excellent results for all assessed outcome variables, with no significant differences between the two implant groups; however, regardless of the prosthesis type, a mean extension deficit of 18.5° ± 1.7° remained at latest follow-up. Although complication and surgical revision rates were comparable (bipolar, 23%; monopolar, 18%), significantly more bipolar prostheses were explanted because of painful loosening (16% vs. 3%; p = 0.029). Good to excellent mid-term results for radial head arthroplasty of comminuted radial head fractures can be achieved using both a bipolar and a monopolar radial head implant; however, the monopolar implant may be preferable, as it had a lower rate of painful loosening. Extension deficit occurs regularly. Level III Retrospective comparative treatment study.

Press-fit stemとsmooth stem人工橈骨頭の治療成績

Press-fit stemとsmooth stem人工橈骨頭の治療成績

Correlation between radiographic findings and clinical failure in monopolar radial head replacement.

The purpose of this study is to analyze the mid-term outcomes of a modular monopolar type of radial head arthroplasty in the treatment of complex fractures associated with acute elbow joint instability. We postulated that radiographic changes are related to the development of clinical complications. We evaluated at last follow-up 26 radial head arthroplasties in 26 consecutive patients who were followed for at least one and a half year. All patients had suffered radial head fractures (Mason III) in the context of unstable elbow injuries. Definitive treatment of the radial fracture was performed with modular and monopolar prosthesis which was inserted as a press fit. All patients were evaluated preoperatively and postoperatively. The evaluation included a clinical examination and a protocolized imaging study (standard X-Rays and CT) of the elbow. We analyzed the incidence of: heterotopic ossifications, secondary radiocapitellar joint osteoarthritis, hardware loosening, hardware disengagement, and joint infection. Diagnosis of clinical failure of the implant was defined as the time to the second surgery due to major complications related to the prosthesis, such as persistent lateral side pain or elbow stiffness and any kind of implant instability or dislocation. Theimplant-specific reoperation rate was 15% (four reoperations). The need for the second surgery was statistically associated with heterotopic ossifications, radiocapitellar osteoarthritis and cortical resorption around radial neck (p = 0.054, p = 0.033, and p = 0.019, respectively), being periprosthetic osteolysis the most likely factor related to failure, and radial pain the main symptom leading to surgical revision. Our study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty. Failed radial head replacements may lead to reoperation mainly due to pain, and this can be distinguished from other causes of pain in elbow region based on its radial location. Radiological loosening was prevalent in this group of failed replacement.

Cemented bipolar radial head arthroplasty: midterm follow-up results

Theoretical advantages of bipolar over monopolar radial head arthroplasty include better accommodation of radiocapitellar malalignment, reduction of capitellar abrasion, and reduction of stress at the bone-to-cement and cement-to-implant interfaces. Our purpose was to report the midterm results of cemented bipolar radial head arthroplasty. Twenty-five patients were treated by cemented bipolar radial head arthroplasty for acute fracture of the radial head, earlier treatment that had failed, or posttraumatic sequelae. One patient refused follow-up after surgery. Results are presented for the remaining 24 patients. At a mean follow-up of 50 months (range, 24-72 months), 1 prosthesis (4%) had been removed 2 years after implantation for dissociation of the prosthesis due to failure of the snap-on mechanism. There were 2 (8%) additional radiologic failures in the subluxated position: 1 prosthesis due to malalignment of the radius onto the capitellum and another due to ulnohumeral erosion. The average flexion-extension arc was 129° (range, 80°-140°), and the average pronation-supination arc was 131° (range, 40°-180°). According to the Mayo Elbow Performance Score, the combined excellent and good results accounted for 83%. In 8 patients, the bipolar design compensated for radiocapitellar malalignment. The overall midterm outcome of this series of 25 cemented bipolar radial head arthroplasties can be considered favorable. There was 1 (4%) revision and 2 (8%) additional radiologic failures. The bipolar design was able to compensate for radiocapitellar malalignment. We suggest considering a cemented bipolar radial head prosthesis in case of concerns about radiocapitellar alignment.

Press-fit bipolar radial head arthroplasty, midterm results

Theoretical advantages of bipolar compared with monopolar radial head arthroplasty include better accommodation of radiocapitellar malalignment, reduction of capitellar abrasion, and reduction of stress at the bone-implant interfaces. Our purpose was to report the midterm results of press-fit bipolar radial head arthroplasty. Thirty patients were treated by press-fit bipolar radial head arthroplasty for acute fracture of the radial head, failed earlier treatment, or post-traumatic sequelae. Three patients were lost to follow-up. Results are presented for the remaining 27 patients. At mean follow-up of 48 months (range, 28-73), there had been 3 (11%) revisions. Two involved conversion to prosthetic radiocapitellar hemiarthroplasty for symptomatic capitellar abrasion; a third involved exchange of the articular component (ie, head) for instability. In all, the stems appeared well fixed. A prosthesis in a subluxed position accounted for the 1 (4%) additional radiologic failure. The average flexion-extension arc was 136° (range, 120°-145°), and the average pronation-supination arc was 138° (range, 70°-180°). According to the Mayo Elbow Performance Score, the combined excellent and good results accounted for 70%. The overall midterm outcome of this series of 30 press-fit bipolar radial head arthroplasties can be considered favorable. Although the revision rate was 11%, the stems were well fixed in all. There was 1 (4%) additional radiologic failure. We suggest considering a press-fit bipolar radial head prosthesis for acute comminuted radial head fractures with limited bone loss of the proximal radius.

Do the radial head prosthesis components fit with the anatomical structures of the proximal radioulnar joint?

The fitting accuracy of radial head components has been investigated in the capitulo-radial joint, and reduced contact after prosthetic replacement of the radial head has been observed. The kinematics of the proximal radioulnar joint (PRUJ) are affected by radial head arthroplasty as well, but have not yet been investigated in this regard. The elbow joints of 60 upper extremities of formalin-fixed body donors were disarticulated to obtain a good view of the PRUJ. Each specimen was mounted on the examining table and radial head position in the native PRUJ was assessed in neutral position, full pronation, and full supination. Measurements were repeated after implantation of mono- and bi-polar prostheses. Analysis of the distribution of the joint contacts in the compartments showed significant differences after radial head replacement. In comparison to the native joint, after bipolar and monopolar radial head replacement, the physiological shift of the proximal radius was altered. The physiological shift of the joint contact of the radial head from anterior to posterior during forearm rotation that was found in the native joint in our cadaver model was not observed after prosthetic replacement. With higher conformity and physiological kinematic of radial head prostheses, possibly lower shear forces and lower contact pressures would be generated. The tested radial head prostheses do not replicate the physiological kinematics of the radial head. Further development in the prosthesis design has to be made. The meticulous reconstruction of the annular ligament seems to be of importance to increase joint contact.

Prótesis de cúpula monopolar en el tratamiento de fracturas y luxofracturas del radio

&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt;&lt;strong&gt;Objetivo: &lt;/strong&gt;&lt;span&gt;Evaluar retrospectivamente los resultados clínicos y radiológicos de una serie consecutiva de pacientes con fracturas y luxofracturas de la cúpula radial a quienes se les realizó el reemplazo por una prótesis monopolar.&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materiales­ y ­Métodos: &lt;/strong&gt;&lt;span&gt;Se incluyeron 20 pacientes. Criterios de inclusión: &amp;lt;18 años, con fracturas o luxofracturas de la cúpula radial, tratados con prótesis monoblock de titanio y seguimiento mínimo de un año. Quince eran mujeres, edad promedio 59 años. Siete eran fracturas aisladas y 13, luxofracturas. Se evaluaron el grado de aflojamiento protésico, la erosión capitelar, el ensanchamiento del espacio articular humeral lateral y las calcificaciones heterotópicas. El seguimiento fue de 26 meses. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados: &lt;/strong&gt;&lt;span&gt;La flexo-extensión fue de 139º-5º y la prono-supinación, de 79-79°. El arco total fue de 134°. Fuerza de puño: 84% del lado contralateral. El dolor según la escala analógica visual fue de 2, DASH: 11 puntos, 13 resultados excelentes y 6 buenos. Se detectó aflojamiento del implante (12 casos), aumento de la radiolucidez capitelar (4 casos) y ensanchamiento del espacio ulnohumeral lateral (2 casos). Hubo 2 complicaciones: una neurodocitis cubital que debió ser operada y una extracción de implante por aflojamiento y dolor.&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;span&gt;&lt;strong&gt;Conclusiones:&lt;/strong&gt; &lt;/span&gt;&lt;span&gt;El reemplazo de la cúpula radial en lesiones no reconstruibles es una opción terapéutica viable, con buenos resultados funcionales a corto y mediano plazo. La recuperación de la estabilidad articular fue posible en todos los casos y el índice de aflojamiento protésico asintomático fue elevado. &lt;/span&gt;&lt;/p&gt;&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt; &lt;/p&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;

요골두 치환술의 임상적 적용

Purpose: Installing a radial head prosthesis has developed into a reliable procedure to replace the native radial head for treating unreconstructible radial head fracture when this is associated with an unstable elbow or forearm. A variety of implants have been developed and these are now commercially available. This article reviews the literature related to the indications, the available implants and the surgical techniques of radial head replacement arthroplasty. Materials and Methods: The main indication for a metallic radial head prosthesis is a comminuted fracture that is not amenable to reconstruction, and particularly if it is associated with complex elbow injuries. Excision of the radial head should be avoided in the presence of combined injured ligaments or interosseous membrane injury. Three different implants are available in Korea, including the bipolar, press fit monopolar and loose fit monopolar radial head prostheses. A primary technical goal of radial head arthroplasty is the insertion of an implant that closely replicates the native radial head. The major pitfall when using a metallic radial head prosthesis is the insertion of a longer implant, which results in overstuffing of the radiocapitellar joint. Results and Conclusion: Satisfactory clinical results can be anticipated when a radial head prosthesis is used for the correct indications and when a systemic approach is undertaken to ensure proper sizing. For the future studies, we need data regarding the long term outcomes and comparison of the various types of prostheses.

Influence of prosthetic design on radiocapitellar concavity-compression stability

Radial head prostheses are available with multiple geometric properties. The effect of design features on radiocapitellar stability has not been investigated. The shape (depth and radius of curvature) of the articulating dish of a radial head prosthesis affects radiocapitellar stability. Radiocapitellar stability due to concavity-compression was evaluated in 8 fresh frozen elbows before and after radial head replacement with 2 different designs of radial head implants (RH 1 and RH 2). Both functioned as monopolar implants. Peak forces resisting subluxation and force-displacement characteristics were compared between the 2 and to the native radial head. Radial head design significantly affected radiocapitellar stability. RH 1, which had a deeper dish than RH 2, required significantly higher peak forces to subluxate the radiocapitellar joint. The peak subluxation forces and the slopes of the force-displacement curves were not significantly different from the native radial head for RH 1, but they were for RH 2. The shape of the articular dish (depth, radius of curvature) of a monopolar radial head implant affects its contribution to radiocapitellar stability. An implant that mimics normal anatomy is more effective than a shallow radial head implant with a radius of curvature that is longer than normal.

Radiocapitellar stability: the effect of soft tissue integrity on bipolar versus monopolar radial head prostheses

Radiocapitellar stability depends, in part, on concavity-compression mechanics. This studywas conducted to examine the effects of the soft tissues on radiocapitellar stability with radial head prostheses. Monopolar radial head implants are more effective in stabilizing the radiocapitellar joint than bipolar radial head prostheses, with the soft tissues intact or repaired. Twelve fresh frozen elbow specimens were used to evaluate radiocapitellar stability with monopolar and bipolar radial heads. The study variables focused on varying soft tissue conditions and examined the mean peak subluxation forces put forth by each prosthesis design. With the soft tissues intact, the mean peak force resisting posterior subluxation depended significantly on the radial head used (P = .03). Peak force was greatest for the native radial head (32 ± 7 N) and least with the bipolar prosthesis (12 ± 3 N), with the monopolar prosthesis falling in between (21 ± 4 N). The presence of soft tissues significantly affected the bipolar implant's ability to resist subluxation, though it did not significantly impact the native or monopolar radial heads. This study reveals the dependence of radiocapitellar stability on soft tissue integrity, particularly for bipolar prostheses. Overall, monopolar prostheses have a better capacity to resist radiocapitellar subluxation. From a biomechanical perspective, the enhancement of elbow stability with a monopolar radial head prosthesis is superior to that with a bipolar design. This is especially true when the integrity of the soft tissues has been compromised, such as in trauma.

Plain Radiographs Are Inadequate to Identify Overlengthening With a Radial Head Prosthesis

A correctly sized radial head implant helps restore more normal elbow motion and load distribution and allows the collateral ligaments to heal in an anatomic position. No single method of measurement has been agreed on. We hypothesized that plain radiographs could be used to evaluate the appropriate length of a radial head prosthesis when we simulated different patterns of ligament disruption. Osteotomies of the medial and lateral condyles were created in 6 cadaver specimens to simulate 4 conditions: ulnar collateral ligament (UCL) and lateral ulnar collateral ligament (LUCL) intact, UCL intact, LUCL intact, and UCL and LUCL disrupted. Radial heads were resected and replaced with correctly or incorrectly sized monopolar radial head implants. Radiographs were taken after simulated ligament injury with a radial head prosthesis that was either 2 mm too short, the appropriate length, or too long by either 2 or 4 mm. Measurements were recorded between radiographic markers to determine ulnohumeral joint displacement. A 4 x 4 x 2 repeated-measures analysis of variance was performed, as well as post hoc analyses using Tukey's honest significant difference test, to determine statistically significant changes in our radiographic measurements. Results showed that disruption of at least 1 ligament alters the ulnohumeral joint separation on the lateral but not on the anteroposterior radiograph. Overlengthening the radial head did not result in a statistically significant change in ulnohumeral space. Replicating radial length is an important but sometimes difficult step during radial head replacement. Standard radiographic assessment of the ulnohumeral joint will not demonstrate marked changes in the ulnohumeral space when the implant is underlengthened by 2 mm or overlengthened by as much as 4 mm, as long as the joint remains located. Disruption of at least 1 collateral ligament alters the ulnohumeral joint separation on the lateral but not on the anteroposterior radiograph.

A primarily overlooked and incorrectly treated Essex-Lopresti injury: what can this lead to?

What result can one expect in treating an Essex-Lopresti lesion--a rare complex combination injury of the forearm consisting of a radial head fracture and a rupture of the interosseous membrane--which failed to be identified at first? We report on a 45-year-old poly traumatized patient in which a primary Essex-Lopresti injury was overlooked following a dislocated radial head fracture. A radial head resection followed by an ulna-shortening osteotomy was performed with disastrous consequences at another clinic. As a result of persistent instability in the distal radioulnar joint, we implanted a mono-polar radial head prosthesis, which was subsequently changed as a result of a loosening of the prosthesis and persistent complex instability and pain in the area of the entire forearm, while an ulna osteotomy had to be carried out to correct this. This prosthesis also loosened, which destroyed the capitulum humeri. It was only after a specially designed modular radial head prosthesis with a capitulum shield was implanted and an elapse of 5(1/2) years of the illness that permanent stability could be achieved on the forearm and the pain experienced by the patient eliminated while at the same time the patient regained a moderate degree of functioning and grip strength. An overlooked primary and ultimately initially incorrectly treated Essex-Lopresti injury can degenerate into a real therapeutic disaster. Years of illness and multiple corrective operations which only serve to limit the collateral damage caused by the wrong therapy strategy and ultimately only lead to restoration of moderate function. The crucial factor is an early diagnosis. Then a radial head prosthesis should first be implanted in an operation in order to prevent an additional proximal migration of the radius and to move the distal radioulnar joint into the proper anatomical position.