American Association for Hand Surgery

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Relationship of the radial head safe zone to the bicipital tuberosity
Damian Fountain, BS1, Nathan Hoekzema, MD2, Allicia Imada, MD1, Robert Gray, MD3, Jorge Orbay, MD4, Francisco Rubio, MD4, Deana Mercer, MD1
1University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, 2University of California Fresno, Fresno, CA, 3NorthShore University HealthSystem, Glenview, IL, 4Miami Hand and Upper Extremity Institute, Miami, FL

Introduction: In treating proximal radius fractures involving the radial head and neck, it is difficult to discern the correct anatomical plate position to avoid abutment at the proximal radial ulnar joint. Current techniques are difficult to apply intraoperatively with complex fractures. We hypothesized that 1) the bicipital tuberosity can be easily and reproducibly visualized fluoroscopically and 2) the imaging findings can confirm radial head plate position in the safe zone.

Materials & Methods: We identified the anatomical safe zone as described by Caputo et al. and Smith and Hotchkiss of 17 cadaveric radial heads using two different techniques. We placed a proximal radial head plate in the safe zone and determined the position of the zone in relation to the bicipital tuberosity.

Results: The anatomical safe zone was accurately identified. The plates placed within 15 of the 180 point to the bicipital tuberosity were within the safe zone.

Conclusions: The bicipital tuberosity can be a consistent fluoroscopic landmark in treating proximal radius fractures. Plates are in the safe zone if placed 180 opposite of the bicipital tuberosity, within 15 of the exact 180 position, and will not impinge on the proximal radial ulnar joint.

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