- See:
-
Complex Fractures (
Essex Lopresti Fracture):
-
Pediatric Radial Head Frx:
-
Radial Head Frx & MCL Instability :
-
Radial Neck Fracture:
- Discussion:
- radial head frx is most common type of elbow fracture in adults;
- frx of the radial head occurs primarily in adults, whereas fractures of the
radial neck are more common in children;
- frx of the radial head and neck of the radius generally results from a hard fall on an outstretched hand;
- impact of fall drives head of radius axially onto capitulum of humerus;
- the high frequency of frx in the anterolateral aspect of radial head occurs as a result of lack of subchondral bone under anterolaterl aspect of the radial head;
- because the anterolateral aspect of radial head does not articulate w/ sigmoid fossa, frx in the region are amenable to fixation w/ small screws;
-
associated injuries:
-
frx of the capitellum
-
distal radius frx
- dislocation of the
distal RU joint (
Essex Lopresti Fracture)
- valgus instability (
MCL rupture)
- probably more common than is reported;
- indications for repair of the MCL will be determined based on stability of the elbow thru a functional range of motion;
- rupture of the triceps tendon
-
elbow dislocation:
-
terrible triad: RHF +
MCL +
coronoid process frx;
- Dx and Exam:
- dx of a radial head fracture may be difficult;
- pain, effusion in the elbow, & tenderness on palpation directly over radial head are typical manifestations;
- if frx is displaced, click or crepitus over radial head is detected w/ supination;
- if elbow ROM is limited, then aspirate and inject several cc of lidocaine, and then re-examine;
- check for blocks to flexion-extension as well as supination-pronation;
- wrist tenderness with ROM is common;
- Radiographic Features:
- AP & Lat (look for fat pad sign)
- Radiocapitellar view: forearm in neutral rotation & the x-ray tube angle 45 d. cephalad
- main disadvantage of this classification is that radiographs may underestimate the true degree of comminution;
- Treatment: (based on Mason classification)
-
type I
-
type II
- less than 30% of radial head;
- more than 2 mm displacement
-
type III
-
ORIF of radial head fracture
-
excision of radial head:
-
Posterolateral Rotatory Instability of the Elbow Following Radial Head Resection.
-
The Effect of Radial Head Excision and Arthroplasty on Elbow Kinematics and Stability.
-
radial head implants:
- references:
-
Treatment of displaced segmental radial-head fractures. Long-term follow-up.
-
complex fractures
-
radial head frx & elbow dislocation :
-
radial head frx & MCL instability :
-
Essex Lopresti Fracture
- reference:
-
Radial head fractures and their effect on the distal radioulnar joint. A rationale for treatment.
-
Radial head fracture. A potentially complex injury.
-
Radial head fractures with acute distal radioulnar dislocation.
- Surgical Dissection:
-
posterolateral approach: (
Kocher Approach)
- approach the fascial plane between the
ECU and
anconeus muscle
- direct
lateral approach is preferred by some surgeons because it spares the lateral ulnohumeral ligament;
-
safe zone for implant insertion:
Year Book: Open Reduction and Internal Fixation of Radial Head Fractures.
Displaced fractures of the head and neck of the radius in children: open reduction and temporary transarticular internal fixation. [Review]
Compression screwing of displaced fractures of the head of the radius. G. Shmueli and HZ Herold. JBJS. Vol 63-B (4) 1981. p 535-538.
Fractures of the radial head treated by internal fixation: late results in 26 cases. RD Esser et al. J. Orthop. Trauma. Vol 9. 1995. p 318-323.
Internal fixation of proximal radial head fractures. C Geel et al. J. Orthop. Trauma. Vol 4. 1990. p 270-274.
Uncomplicated Mason Type-II and III Fractures of the Radial Head and Neck in Adults. A Long-Term Follow-Up Study.
Recurrent radial head subluxation treated with annular ligament reconstruction. A case report and follow-up study.
Concomitant fractures of the capitellum and radial head.
Treatment of chronic post-traumatic dislocation of the radial head in children.
Chronic posterior subluxation and dislocation of the radial head.
Open Reduction and Internal Fixation of Fractures of the Radial Head.
Absorbable polyglycolide pins in fixation of displaced fractures of the radial head.
Herbert screw fixation of fracture of the head of the radius.
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