Radial Head Fracture with Medial and Anterior Displacement
Score and Comment on this Case
Clinical Details
Clinical and radiological findings: A male patient sustained a proximal radius fracture without elbow dislocation or coronoid process injury following a motor vehicle accident. Radiographic evaluation revealed that the radial head fragments were displaced medially and anteriorly. The fracture was classified as AO/OTA 21-B2, indicating a partial articular fracture of the radial head.
Preoperative Plan
Planning remarks: The preoperative plan involved attempting osteosynthesis as the first option. The goal was to synthesize the three fragments of the radial head. If adequate reduction could not be achieved, a joint replacement with a prosthesis was planned.
Surgical Discussion
Patient positioning: The patient was positioned supine on the operating table.
Anatomical surgical approach: A Kocher approach was utilized for the surgical procedure. This involved an incision along the lateral aspect of the elbow, starting just distal to the lateral epicondyle and extending distally along the interval between the extensor carpi ulnaris and anconeus muscles. Subperiosteal dissection was performed to expose the radial head and neck.
Operative remarks:The radial head was successfully synthesized using headless compression screws (HCS). One screw was placed to fix the radial head to the neck, and another screw was used to secure an intact fragment of the radial head. For the smallest fragment, a Kirschner wire was employed for fixation.
Postoperative protocol: Postoperatively, the patient was advised to avoid splinting during the day and to maintain touch weight-bearing (TWB) for 4 weeks. Partial weight-bearing (PWB) was recommended from week 5, progressing to full weight-bearing (FWB) by week 6 post-surgery.
Follow up: Not specified
Orthopaedic implants used: Orthopaedic implants used: - Headless Compression Screws (HCS) - Kirschner wire
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User Discussion (1)
Cubitus Mundi
Do you think there’s a humeral sided MCL injury with that medial opacification? Not sure I would be confident to say there was no dislocation
I also cannot be sure that there was no dislocation, but I have no record in history or on x-ray of a dislocation. I did not find medial instability in the operating room, I think that the medial fragment may correspond to a very displaced metaphyseal fragment of the radius.