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Surgery of the Elbow
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Alan Salih, David Butt, Deborah Higgs
The anteromedial portal is established under direct vision and the arthroscope introduced to view the radioulnar and radiocapitellar articulations plus the annular ligament. Extending the elbow reveals more of the capitellum, and forearm rotation exposes more of the radial head. The anterolateral gutter and capsule should also be examined.
The injured child
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
In the upper limb, supracondylar fractures of the humerus are common in younger children. Scaphoid injuries are very rarely seen in young children but begin to appear when approaching puberty. Distal radial and radial head injuries are more likely.
Single best answer (SBA)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
A small anterior fat pad manifesting as a lucency immediately anterior to the distal humerus on the lateral radiograph may be seen in normal individuals. However elevation or increased size of the fat pad is abnormal and indicative of a joint effusion. A posterior fat pad is always abnormal, in the context of trauma, haemarthrosis secondary to an occult fracture is the likeliest explanation. In this patient’s age group, the radial head is most likely to be injured; in children supracondylar fractures are more common. These injuries are often treated as radial head fractures even if a definite fracture line cannot be identified.
An anterolateral dislocated monteggia lesion with plastic lateral bowing of the ulna associated with ipsilateral epiphyseal fracture of the distal radius: a case report with 4 years of follow-up
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Mitsuhiko Takahashi, Ryo Miyagi, Hirofumi Kosaka, Hiroshi Egawa
A literature search identified five case reports describing combinations of various types of Monteggia lesions and ipsilateral epiphyseal fracture of the distal radius [14–18]. In all cases, the injury was associated with a fall from height and included an ulna fracture and an ipsilateral Salter-Harris type II lesion of the distal radius. The direction of dislocation of the radial head was anterior (Bado type I) in two cases, posterior (type II) in 1 case, and lateral (type III) in two cases. In all cases, open reduction was needed after failure of closed reduction. To our knowledge, this is the first report of a Monteggia lesion with plastic deformity of the ulna associated with ipsilateral epiphyseal fracture of the distal radius. The mechanism of this type of injury was not clear. Both Evans and Bado mentioned that type I and II lesions are often accompanied by lesions of the distal radius but neither provided any supporting data [1,3]. The likely cause of the lesion at the distal radius is a fall on an outstretched arm and the forced pronation mechanism may explain a Monteggia lesion or equivalent. Further research is needed to understand the mechanism of this type of injury.
Clinical and Radiographic Outcomes of Unipolar and Bipolar Radial Head Prosthesis in Patients with Radial Head Fracture: A Systemic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2018
Hongwei Chen, Ziyang Wang, Yongjun Shang
The radial head is an important secondary stabilizer of the elbow. Replacement of the radial head is recommended in cases in which the injury of the ligaments requires a secondary stabilizer, and it is not possible to reconstruct the radial head. Several prosthetic radial head replacements are available, but it is unclear if one is more effective than another in treating radial head fractures. This study evaluated outcomes of unipolar and bipolar radial head prosthesis in patients with radial head fracture. In general, MEPS, DASH score, radiologic assessment, ROM, and grip strength following elbow inplant were similar between prosthetic devices. The pooled mean excellent/good ranking of MEPS was 0.78 for unipolar and 0.73 for bipolar radial head protheses, and the pooled mean MEPS was 86.9 and 79.9, respectively. DASH scores for unipolar and bipolar prostheses were 19.0 and 16.3, respectively. Range of motion outcomes were similar between groups; both prostheses were associated with similar risk of flexion arc, flexion, extension deficit, rotation arc, pronation, and supination (p values <0.001 for both unipolar and bipolar prosthesis). However, bipolar radial head prosthesis had a significant chance heterotopic ossification and lucency (p values ≤0.049) while unipolar prosthesis did not (p values ≥0.088). Both groups had risk for development of capitellar osteopenia or erosion/wear (p values ≤0.039).
Therapeutic Effect of Resection, Prosthetic Replacement and Open Reduction and Internal Fixation for the Treatment of Mason Type III Radial Head Fracture
Published in Journal of Investigative Surgery, 2021
Hong-Wei Chen, Jia-Liang Tian, Yong-Zhao Zhang
Radial head fractures are one of the most frequent fractures in elbow joints with cartilaginous, ligamentous and sometimes other bony damages.[19] Previous studies have confirmed that radial head resection, prosthetic replacement, and ORIF are all viable surgical methods for radial head fracture repair [3,5,20]. The clinical efficacy and postoperative complications of these three treatment methods are different, which makes it difficult for physicians and patients to choose the most appropriate treatment method. Therefore, this study explored the efficacy of different surgical methods for the treatment of Mason type III radial head fractures and provided a reference for the determination of treatment methods of such fractures.