Radial Head Fractures

Question 1

What percentage of radial head fractures have associated soft tissue or boney injuries?

Answer 1

30%
distal radioulnar joint (DRUJ) injuries
interosseous membrane disruption
coronoid fractures
MCL/LCL injuries
Essex-Lopresti lesion (DRUJ) injury plus radial head fracture
elbow dislocation
terrible triad (elbow dislocation, radial head fx, coronoid fx)
carpal fractures

Question 2

What is the classification of radial head fractures?

Answer 2

Mason:
I- minimally displaced 2mm, possible mechanical block
III- comminuted and displaced, mechanical block to motion
IV- any radial head fx with elbow dislocation

Question 3

What physical exam procedures are important with radial head fractures?

Answer 3

1) evaluate for blocks to motion (hematoma block first)
2) palpate wrist for DRUJ tenderness
3) palpate interosseous membrane for tenderness

For XR can get a Greenspan or radiocapitellar view (45° oblique lateral)

Question 4

What are surgical indications for ORIF of radial head fractures?

Answer 4

1) Mason Type II with mechanical block
2) Mason Type III where ORIF feasible
3) Mechanical block to motion
4) Presence of other associated complex elbow injuries

Question 5

What are indications for radial head replacement in radial head fractures?

Answer 5

1) Mason III with 3 or more fragments where ORIF not feasible
2) elbow fracture-dislocations or Essex Lopresti lesions

Question 6

What location should screws or plates be placed during ORIF of a radial head fracture?

Answer 6

(arc of Caputo)-90-110° arc between the area congruent with Lister’s tubercle and radial styloid that is a bare area; place arm in neutral

Question 7

What two surgical approaches are used for radial head ORIF or arthroplasty?

Answer 7

Kocher- btw anconeus and ECU (LCL at risk)
Kaplan- btw ECRB and EDC (PIN at greater risk)

Must keep forearm pronated for both approaches to protect PIN

Question 8

What is the most sensitive way to avoid overstuffing during radial head arthroplasty?

Answer 8

Direct visualization; performed by visualising the lateral aspect of the ulnohumeral joint when the radial head is resected and comparing this to when the trial radial head is reduced in place.

Question 9

In a patient with a Mason I radial head fracture what is the recommended treatment?

Answer 9

Arm sling for 48hrs followed by AROM