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Elbow Dislocations With Associated Radial Head Fracture

Introduction

  • 5-11% of elbow dislocations
  • Often results in a stable elbow even if the radial head is excised or unrepaired
  • Short-term functional results of radial head excision are good, but there is an associated 80% incidence of early degenerative changes
  • The radial head should be repaired or replaced
    • Fragments involving less than 1/3 of the radial head can be excised
    • Residual instability/soft tissue compromise after a dislocation placed added strain on the radial head and may compromise the repaired construct
    • ...link ro radial head fractures...

Differential Diagnosis

  • Essex-Lopresti Fracture (radial head fracture with dislocation of distal radioulnar joint and interosseous membrane injury)

Classification of Radial Head Fractures

Mason Classification

  • Type I: Nondisplaced fractures
  • Type II: Marginal fractures with displacement
  • Type III: Comminuted fractures involving the entire head
  • Type IV: Radial head fractures associated with dislocation of the elbow

Treatment

Type I Fractures:

  • Splint or sling for a few days followed by early active range of motion
  • One may aspirate hematoma and inject joint with lidocaine

Type II Fractures:

  • The radial head should be preserved (ie repaired or replaced)
  • Fragments involving less than 1/3 of the radial head can be excised
  • Residual instability/soft tissue compromise after a dislocation placed added strain on the radial head and may compromise the repaired construct

Type III Fractures:

  • Short-term functional results of radial head excision are good, but there is an associated 80% incidence of early degenerative changes
  • excision is contraindicated when associated with collateral ligament or interosseous membrane injury
  • Consider ORIF for fractures with 3 or fewer fragments
  • Radial head replacement is indicated for fractures with more than three fragments

Pearls and Pitfalls

Tips and problems to avoid

Postoperative Care

Include immediate postoperative care and rehabilitation

Outcome

Include functional and prosthetic survivorship data as applicable

Complications

Include overview of complications

References

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