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. 2022 Jun;10(6):501-506.
doi: 10.22038/ABJS.2021.55486.2764.

Posteriorly Displaced Radial Head Fractures May Represent the Footprint of an Elbow Dislocation or Subluxation as a Variant of Modified Mason Type 4

Monica M Shoji  1 , Magdalena Hartwich Garcen  2 , Alberto A Fernandez Dell'Oca  2 , Jesse B Jupiter  3
Affiliations

Posteriorly Displaced Radial Head Fractures May Represent the Footprint of an Elbow Dislocation or Subluxation as a Variant of Modified Mason Type 4

Monica M Shoji et al. Arch Bone Jt Surg. 2022 Jun.

Abstract

Background: The purpose of this case series is to describe surgical decision making and clinical outcomes in posteriorly displaced radial head fractures with a major fragment (more than 50% of the head) located behind the humeral condyle. We also document the outcome of open reduction and internal fixation of completely displaced radial head fractures.

Methods: A retrospective review of the ICUC® (Integrated Comprehensive Unchanged Complete) database was performed between 2012 and 2020. Patients were included if preoperative radiographs demonstrated a major radial head fracture fragment located posterior to the humeral condyle and a minimum of 2-year follow-up data was available.

Results: Ten patients met inclusion criteria. Two patients had an associated elbow dislocation whereas 8 patients did not. All patients were found to have disruption of the lateral collateral ligament complex intraoperatively. Nine radial head fractures were successfully fixed with interfragmentary screws. One multi-fragmented radial head fracture could not be successfully stabilized with interfragmentary screw fixation and was resected. The average time to final follow-up was 4.8 years (range 2.2-8.1). At final follow-up, 6 patients demonstrated radiographic evidence of a healed radial head, 1 patient had avascular necrosis, and 2 had post-traumatic arthritis. None demonstrated radiographic instability. The average functional score was 0.64 (SD 0.81) and pain score was 0.45 (SD 0.93). The average elbow extension was 8 degrees (SD 11), elbow flexion was 139 degrees (SD 6), forearm supination was 60 degrees (SD 27), and forearm pronation was 69 degrees (SD 3).

Conclusion: Recognition of a posteriorly displaced radial head fracture is essential, as it may be an indirect sign of elbow instability. This instability should be addressed during surgical intervention.

Keywords: Elbow; Elbow dislocation; Radial head fracture; Trauma.

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Figures

Figure 1
Figure 1
Radial head fracture with a posteriorly dislocated fragment without evidence of elbow dislocation on injury films (A-C) Injury films show the posteriorly dislocated radial head fracture fragment and likely subluxated ulnohumeral joint, better visualized on the 3-dimensional CT scan. (D-F) Postoperative radiographs after primary fixation of the radial head and repair of the LCL complex, showing a healed radial head and concentric ulnohumeral at final follow-up without evidence of avascular necrosis or instability
Figure 2
Figure 2
Radiographs of patient with posteriorly dislocated radial head fracture with associated elbow dislocation. (A-C) Injury films show the posteriorly dislocated radial head fracture fragment, dislocated elbow joint without evidence of a coronoid fracture, better visualized on the 3-dimensional CT scan. (D-E) Immediate postoperative radiographs, showing fixation of the radial head fracture fragment and LCL complex. Notably, the elbow was still unstable intraoperatively and required temporary application of external fixation across the elbow joint. (F) Postoperative radiographs after external fixator removal, showing a healed radial head and concentric ulnohumeral without evidence of avascular necrosis or instability
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