Arthroscopic Radial Head Fracture Fixation

Lee Hunter MD, MBA

Hunter Medical Founder and Chief Medical Officer

February  2019

 

Radial head fractures are very common injuries and can usually be treated conservatively. Displaced fractures require either ORIF or radial head replacement. Displaced 2 part fractures can sometimes be reduced and stabilized arthroscopically.

57 YOF WITH DISPLACED RADIAL HEAD FRACTURE/CORONOID FRACTURE

The patient fell onto her dominant arm, sustaining a displaced and impacted radial head fracture, along with a non-displaced coronoid fracture. She was seen in an ER and treated with a sling, and presented to my office 3 days after her injury. She had already regained a reasonable arc of elbow flexion/extension, but had a mechanical block to forearm rotation. Her injury films are shown below.

The Procedure

The patient was placed in the supine position utilizing the ElbowLOC® Arm Positioning System. Double anterolateral and standard anteromedial portals were established. A small elevator was utilized to reduce the radial head fracture, then screws were inserted through one of the lateral portal incisions, manipulating the forearm as needed. The coronoid fracture was non-displaced and stable on arthroscopic exam and was treated conservatively. The collateral ligaments were intact. Intraoperative arthroscopic photos and four month post op X-rays are below. The patient wore a sling for comfort postoperatively, and began supervised physical therapy 2 weeks post op. Four months post-op, she had no pain, full forearm rotation, a 5 degree flexion contracture and flexion to 140 degrees. 

Arthroscopic Gross Fracture Reduction Reduction After Screw Placement 

ElbowLOC Supine Positioner stabilizes the humerus vertically, and thus gives the surgeon independent control of the elbow joint and forearm. Freedom of manipulation of the forearm and elbow joint is critical for arthroscopic screw placement and confirmation of unobstructed range of motion. This is another reason why arm positioners that capture the forearm are difficult to use for supine elbow arthroscopy.

 

This case is another great example of how the ElbowLOC® simplifies and accelerates procedural times for many elbow surgeries and makes surgery easier for the surgeon, patient, and staff!

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