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Radial Head Frx

- See: 
      - Adult Radial Neck Frx / Pediatric Radial Head Frx

- Discussion:
    - radial head frx is most common type of elbow fracture in adults;
    - frx of the radial head occurs primarily in adults, whereas fractures of the radial neck are more
           common in children;
    - frx of the radial head and neck of the radius generally results from a hard fall on an outstretched hand;
           - impact of fall drives head of radius axially onto capitulum of humerus;
    - high frequency of frx in anterolateral aspect of radial head occurs as a result of lack of subchondral bone
           under anterolaterl aspect of radial head;
           - because the anterolateral aspect of radial head does not articulate w/ sigmoid fossa, frx in the region are amenable to fixation
                   w/ small screws;
    - associated injuries:
           - frx of the capitellum
           - distal radius frx
           - dislocation of the distal RU joint (Essex Lopresti Fracture)
           - valgus instability (MCL rupture)
                  - probably more common than is reported;
                  - indications for repair of the MCL will be determined based on stability of the elbow thru a functional range of motion;
           - rupture of the triceps tendon
           - elbow dislocation:
            - terrible triad: RHF + LCL / MCL + coronoid process frx;
                  - Risk of Subluxation or Dislocation after Operative Treatment of Terrible Triad Injuries.
                  - Terrible triad injuries of the elbow: does the coronoid always need to be fixed?
                  - Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis
                  - Terrible Triad Injuries of the Elbow
                  - Outcomes of coronoid-first repair in terrible triad injuries of the elbow
                  - Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study
                  - Radial head replacement vs reconstruction for treatment of terrible triad injury of the elbow: a review and meta-analysis

- Dx and Exam:
    - dx of a radial head fracture may be difficult;
    - pain, effusion in the elbow, & tenderness on palpation directly over radial head are typical manifestations;
    - if frx is displaced, click or crepitus over radial head is detected w/ supination;
    - if elbow ROM is limited, then aspirate and inject several cc of lidocaine, and then re-examine;
           - check for blocks to flexion-extension as well as supination-pronation;  
    - wrist tenderness with ROM is common;

- Radiographic Features:
      - AP & Lat (look for fat pad sign)
      - Radiocapitellar view: forearm in neutral rotation & the x-ray tube angle 45 d. cephalad 
      - main disadvantage of this classification is that radiographs may underestimate the true degree of comminution;
      - references:
            - Magnetic resonance imaging in radial head fractures: most associated injuries are not clinically relevant.
            - The cortical irregularity in transition zone of radial head and neck: a reliable radiographic sign of occult radial head fracture.


- Treatment: (based on Mason classification)
    - type I
    - type II
          - less than 30% of radial head;
          - more than 2 mm displacement 
          - ORIF of radial head fracture
    - type III 
          - excision of radial head
          - radial head implants:
          - references:
                 - Treatment of displaced segmental radial-head fractures. Long-term follow-up.
    - adult radial neck fracture
    - complex fractures
          - radial head frx & elbow dislocation 
          - radial head frx & MCL instability 
          - Essex Lopresti Fracture
          - references:
                - Radial head fractures and their effect on the distal radioulnar joint. A rationale for treatment.
                - Radial head fracture. A potentially complex injury.
                - Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited. 

- Surgical Considerations: 
    - posterolateral approach: (Kocher Approach)
          - approach the fascial plane between the ECU and anconeus muscle
          - direct lateral approach is preferred by some surgeons because it spares the lateral ulnohumeral ligament; 
    - ORIF of radial head fracture / safe zone for implant insertion
    - radial head replacement:

Fractures of the radial head treated by internal fixation: late results in 26 cases.   

Internal fixation of proximal radial head fractures.  

Uncomplicated Mason Type-II and III Fractures of the Radial Head and Neck in Adults. A Long-Term Follow-Up Study.

Recurrent radial head subluxation treated with annular ligament reconstruction. A case report and follow-up study.

Open Reduction and Internal Fixation of Fractures of the Radial Head. 

In Brief: The Mason Classification of Radial Head Fractures

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