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Radial Head Frx & Elbow Dislocation

- See:
    - Dislocations of Elbow:
    - Radial Head Frx:
    - Management of Complex Elbow Dislocations

- Discussion:
    - upto 10 % of comminuted frx of radial head occurr in assoc w/ elbow dislocation;
    - there is usually significant soft tissue injury of both joint capsule & brachialis;
    - result is often joint stiffness, degenerative changes, & myositis ossificans;

- Radiographs:
    - proximal translation of the radius;
    - it is important to have adequate views of the wrist early on in order to follow proximal radial translation later on;


- Treatment: Frx Dislocation: (radial head frx):
    - type-I frx:
         - w/ concomitant post elbow dislocation, early ROM is recomended;
         - assoc w/ elbow dislocation are protected in splint for 10-14 days;
         - then encourage intensive active ROM, since late instability rarely occurs after this injury;
    - type-II frx:
         - radial-head frx are treated w/ ORIF;
         - this frx-dislocation w/ single displaced frag is ideal indication for ORIF of radial head;
         - non-articulating portion of radial head is most common portion to be frxed which is convenient since it better lends itself  to
                   fixation and avoids hardware interferance w/ forearm rotation;
         - at the time of surgery, look for injury to the lateral ligamentous complex, and consider operative repair if instability is an issue; 
         - ref: Fractures of the radial head
    - type III frx:
         - best method of treatment is controversial; 
                - w/ 3 or less fragments (two articular fragments and the neck) and no metaphyseal comminution, ORIF may be attempted;
                - note that there is high chance of fixation failure;
         - open reduction and internal fixation:
                - in young patients w/ good bone stock, even high comminuted fractures can often be pieced together;
                - in come cases, iliac crest bone grafting is necessary to connent the head fragment to the radial shaft;
                - ref: Salvage of the head of the radius after fracture-dislocation of the elbow. A case report. 
         - radial implants:
         - excision of radial head:
                - comminuted frx w/ elbow dislocation can be treated w/ early, complete excision of radial head & immobilization for upto 3 weeks;
                - because radial head maintains about 30% of total resistance to valgus loading, concomitant MCL rupture (as might be
                         seen w/ low coronoid process frx), may lead to severe instability;
                - excision should only be considered when the MCL is intact;
                - despit this, many radial head fractures with an elbow dislocation, can be treated w/ radial head excision and delayed
                           motion in a hinged brace;
                - complications:
                       - may lead to severe instability and late joint arthrosis;
                - outcomes:
                       - in the report by Sanchez-Sotelo J, et al, the authors treated 10 elbow dislocations w/ associated radial head fractures
                              and no other injuries (i.e., no coronoid process frx);
                              - authors emphasize the need for secure repair of the lateral ligamentous structures is essential;
                              - 2 pts showed gross instability, and in these, pinning w/ transarticular wires did not appear to affect results (mean
                                       mobilization time=23 days);
                              - results were excellent in 4, good in 5, and fair in 1 patient;
                              - mean flexion was from 7.5 to 140 deg and no elbow was unstable;
                              - proximal migration of the radius measured 1.6 mm (two patients had 4 mm of migration and wrist pain); 
                       - Results of acute excision of the radial head in elbow radial head fracture-dislocations. 
   - frx dislocation w/ MCL injury:
         - radial head frx & MCL Instability:
         - marked valgus displacement of elbow causes compression of radial head along w/ disruption of MCL;
         - this pattern of injury may present as radial neck frx;
                - treatment involves ORIF of  radial neck frx w/AO mini-plate;
                - this stabilizes lateral column & allows MCL to heal; 

- Terrible Triad: (dislocation, cornoid process frx, and radial head frx)

The use of frozen-allograft radial head replacement for treatment of established symptomatic proximal translation of the radius: preliminary experience in five cases.

Primary replacement of the fractured radial head with a metal prosthesis.  

Valgus stability of the elbow.

Resection of the radial head: an alternative to use of a prosthesis?

Posterior Dislocation of the Elbow with Fractures of the Radial Head and Coronoid. 

Medial oblique compression fracture of the coronoid process of the ulna.

Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique.

Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow.

The pathoanatomy of lateral ligamentous disruption in complex elbow instability.