Radial Head Fractures - Alistair Jepson 30/1/2001

BACKGROUND

Mechanism of injury:

(i) F.O.S.H. - force transmitted along line of forearm producing valgus stress at elbow (may also cause a capitellar #)

- greater carrying angle in women postulated as reason for higher incidence in women

(ii) direct blow to elbow

Mechanism likely to be a good predictor for the type of # too

Classification:

Mason (Br J Surg 1954)

Type I : 'fissure or marginal #'s without displacement' (lateral quadrant)

Type II : 'marginal sector fractures with displacement' (displaced, impacted or tilted)

Type III : 'comminuted #'s involving the whole head of the radius'.

Often quoted as:

I : undisplaced radial head #

II : displaced # with either >2 or 3mm step in articular surface, >30 ° angulation or >30% of head involvement

III : comminuted #

Then either simple or complex depending on whether assoc with another # or ligamentous injury such as dislocation

This classification has since been modified by:

a) Johnston (Ulster Med J 1962) adding IV : radial head # assoc with dislocation of the elbow (~5-10% of all radial head #'s and conversely same % of dislocations associated with radial head #'s),

b) Hotchkiss (J Am Acad Orthop Surg 1997) to include completely displaced #'s of the radial head assoc with radial neck #

Fracture mechanics:

o Other #'s assoc with radial head # are proximal part of ulna, occasionally distal humerus, particularly capitellum

o Associated ligamentous injuries are very important

- Medial collateral ligament of elbow (1 ° stabiliser of the elbow)

- Lateral collateral ligament

- Distal radio-ulnar joint - Essex Lopresti injury = Acute Distal Radio-Ulnar disruption

o occurs in ~5% of all radial head #'s

o should be examined for clinically (tenderness at DRUJ)

o best XR to show is a lateral wrist with hand in full pronation (distal ulna will sublux dorsally)



This is a preview of the site content. To view the full text for this site, you need to log in.
If you are having problems logging in, please refer to the login help page.


© 2005-2007 Orthoteers.co.uk - last updated by Dushan Atkinson on 12 February 2006Medical Marketing by Blue Medical 
Biomet supporting orthoteersThe British Orthopedic Association supporting OrthoteersOrthoteers is a non-profit educational resource. Click here for more details
Coronoid Fractures - Chris Huber 1...
Distal Humeral Comminuted Intra-art...
Elbow Instability - Callum Clark 1...
Fractures of the coronoid process ...
Olecranon Fractures - Simon Colerid...
Radial Head Fractures - Alistair Je...
Radial Head Fractures and Elbow Ins...
OWLS Advertise on Orthoteers
Orthoteers Junior Orthoteers Orthopaedic Biomechanics Orthopaedic World Literature Society Educational Resources Image Gallery About Orthoteers Orthoteers Members search
Hide Menu