Triad Variant with Radial Head Extrusion

Lee Hunter MD, MBA

Hunter Medical Founder and Chief Medical Officer

August  2019

This is an unusual case of an elbow fracture/dislocation with an extruded radial head and an intact proximal ulna.

48 YO RHDF WITH ELBOW DISLOCATION AND ANTEROMEDIALLY EXTRUDED RADIAL HEAD

The patient fell off her porch onto her extended left arm, sustaining the injury shown below. She reports immediately seeing her elbow “crooked” and states that she grabbed her forearm with her dominant hand, jerked, and felt her elbow pop back into place. Below are her left elbow and wrist X-rays and CT from the ER, where she was placed in a splint. No reduction was performed in the ER. She presented to my office 2 days later. Neurovascular exam was normal.

 

      

Surgery was performed with the patient supine using the ElbowLOC® Arm Positioning System. A standard posterolateral approach was performed. Both collateral ligaments had been stripped off the humerus. The proximal ulna including the coronoid was intact. The brachialis insertion was shredded along with much of the proximal forearm musculature. The radial head was faintly palpable anterior and medial to the ulna but could not be visualized. The median and anterior interosseous nerves could easily be seen from the posterior approach. I removed the radial head through an anteromedial incision, with the arm extended on our radiolucent hand table as shown below. I inserted a radial head implant and repaired the lateral collateral ligament and lateral soft tissue envelope. The elbow was stable to full extension at this point, so the ulnar collateral ligament was not surgically repaired. At her one-week post op visit, a hinged elbow splint with a 30-degree extension block was applied, and she was referred for supervised hand therapy. Below are radiographs taken 4 weeks post op, where she had full forearm rotation, extension to 20 degrees, and 115 degrees of flexion.

 

The ElbowLOC® System along with our radiolucent hand table allows the surgeon to easily switch from a posterior to an anterior elbow approach throughout a surgical procedure. This is a huge advantage versus other arm positioners which limit surgeon’s intraoperative access to one particular approach.

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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