|Beitragstitel||Radius shaft fracture combined with a dislocation of the radial head – A rare pattern of injury|
Combinations of forearm fractures and dislocations of adjacent joints are well described in the literature, i.e. Monteggia fracture, Galeazzi fracture or Essex-Lopresti lesion. We present a case with a combination of a radial diaphyseal fracture with a ventral dislocation of the radial head.
A male patient (28y) presents after a bicycle accident with a fall onto the outstretched left arm. Preoperative X-rays showed a radial fracture at the middle of the diaphysis. There was also suspicion of possible dislocation in the distal radioulnar joint. After open reduction and internal fixation (ORIF) of the radius shaft fracture, the distal radioulnar joint appeared to be reduced and stable. Surprisingly the postoperative X-ray revealed a anterior dislocation of the radial head. On day 2 postoperatively, an attempt of closed reduction of the radial head luxation failed. Revision surgery with open reduction, suture of the annular ligament and refixation of the capsular ligamentous complex to the lateral epicondyle with a suture anchor, was performed. Postoperative X-rays showed a correct articulation of the joint. For 6 weeks the patient performed non-weight-bearing mobilization in an elbow motion orthosis, followed by increased strengthening. Three months postoperativly, the patient was nearly asymptomatic with regular radiologic follow up, slightly limited range of motion (flexion/extension 120/5/0°; pro-/supination 70/0/50°) and stable joint.
On closer inspection of the radiograph: An osseous fragment in the region of the interosseous membrane (IOM) can be seen, indicating a possible osseous avulsion. Hence, we assume the presence of an unidentified concomitant lesion of the interosseous membrane and rupture of the annular ligament without sub-/luxation in the elbow. To our best knowledge, this is the first published case, describing the combination of these injuries. However, in biomechanical studies the function of the interosseous membrane as important stabilizer of the radial head is described.
The combination of a radius shaft fracture and a dislocation of the radial head is very rare and to our best knowledge, not yet described in the literature. If a lesion of the IOM is present, an instability of the radial head should be excluded. In this situation, we recommend a careful intraoperative clinical and radiologic evaluation of the stability of the radial head.