Overview
What are radial head fractures and dislocations?
What is the anatomy of the elbow joint relevant to radial head fractures and dislocations?
What is the pathophysiology of radial head fractures and dislocations?
What causes radial head fractures and dislocations?
What is the prevalence of radial head fractures and dislocations?
What is the prognosis of radial head fractures and dislocations?
Presentation
Which clinical history is characteristic of radial head fractures and dislocations?
What should be included in the physical exam of radial head fractures and dislocations?
Workup
What is the role of imaging studies in the diagnosis of radial head fractures and dislocations?
Treatment
What is the goal of treatment for radial head fractures and dislocations?
What is the role of implants in the treatment of radial head fractures and dislocations?
What are the treatment options for radial head fractures and dislocations?
When is nonsurgical treatment indicated for radial head fractures?
How are radial head fractures classified?
When is surgery indicated for radial head fractures and dislocations?
What are Monteggia fractures and how are they classified and treated?
What are floating elbow injuries and how are they treated?
What is the initial approach to surgery for radial head fractures and dislocations?
What is the basis for surgery selection in radial head fractures and dislocations?
What are the options for fixation in the treatment of radial head fractures and dislocations?
How are radial head fractures and dislocations treated in children?
What is the role of excision in the treatment of radial head fractures?
What is the best treatment for Monteggia fracture-dislocations?
What is the treatment approach for unstable radial head fractures?
What is the treatment approach for elbow fracture-dislocations?
What are the early complications of radial head fractures and dislocations?
What are the late complications of radial head fractures and dislocations?
How are infection and persistent pain managed after radial head fractures and dislocations?
How is nonunion after radial head fracture managed?
What are the treatment options for limited motion following radial head fractures and dislocations?
What is included in long-term monitoring of radial head fractures and dislocations?
-
Congenital radial head dislocation.
-
The radial head must be aligned with the capitellum on all views. Simple ulna fracture on anteroposterior view; radial head appears in place but see Image below.
-
The radial head must be aligned with the capitellum on all views. Dislocated radial head is observed on the lateral radiograph.
-
Soft tissue injury. Soft tissues are as important as bone in determining functional outcome.
-
Isolated radial head dislocation is almost always treated closed.
-
Minimally displaced radial head/neck fractures can be treated with early motion.
-
Floating elbow. Combined Monteggia fracture with dislocation and supracondylar humerus fractures. Treatment of a floating elbow requires fixation of both fractures.
-
Displaced radial head fracture.
-
Radial head fracture fixation.
-
Radial head fracture in a child.
-
Radial head fracture in a child.
-
Radial head replacement, Monteggia variant and the radial head could not be salvaged.
-
Radial head replacement, temporary spacer.
-
Radial head excessive excision. Do not excise distal to the annular ligament because the forearm becomes unstable.
-
Radial head replacement, salvage with radial head spacer.
-
Unsuccessful open reduction of Monteggia fracture-dislocation.
-
Displaced radial head fracture.
-
Fixation with hardware pain.
-
Same patient as in Image above. Pain was resolved after hardware removal.
-
Synostosis after Monteggia fracture-dislocation; see Image below.
-
Improved motion after synostosis resection.
-
Monteggia variant with radial head fracture.
-
Fixation of both radial head and ulna.