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Intra-articular Radial Head Fracture With an Entrapped Fragment in a 6-Year-Old Girl

March 01, 2020

Contributors: EYTAN MENDELOW, BS; Camryn Myers; Jennifer Rachelle Ristic, PA-C; Christian Joseph Zaino, MD, BA; Barbara Minkowitz, MD, FAAOS

Intra-articular displaced radial head fractures are extremely rare in skeletally immature patients, who require MRI and/or CT for correct diagnosis. Unfortunately, poor prognosis and complications are associated with intra-articular displaced radial head fractures because of immature physeal closure and annular ligament disruption. Complications may be associated with open reduction and internal fixation (ORIF) in skeletally immature patients. ORIF is necessary for anatomic reduction. Closed reduction often leads to poor results, including 180° degree malalignment of the fracture fragment. This video discusses the case presentation of a 6-year-old girl with a displaced left radial head fracture that was sustained during a fall from the monkey bars. Her left elbow was painful, swollen, and had blocks to extension and rotation. Radiographs demonstrated a fat pad sign and a small ossific fragment in the posterolateral elbow. Advanced imaging studies revealed that the fragment, which was 7 × 8 × 2 mm in size, was from the radial head. The patient was diagnosed with an intra-articular radial head fracture with an entrapped, displaced fragment. The patient underwent ORIF. Intraoperative findings confirmed two fractures. One of the fractures involved the radial head and was minimally displaced and not well visualized on imaging studies. The other fracture was a complex Salter-Harris type IV fracture of the anteromedial radial head face, which was flipped 180° into the posterolateral aspect of the elbow. The fracture fragments were secured with the use of three buried, 0.045-in (1.14-mm) Kirschner wires, and a cast was applied. The wires were surgically removed 6 weeks postoperatively under general anesthesia, and the patient subsequently underwent aggressive physical therapy. At final follow-up, which occurred 10 months postoperatively, the fracture had healed and the patient almost had full range of motion. The patient had full function without pain or limitations. Additional research on radial head fractures in skeletally immature patients is necessary. Evidence on the benefits of ORIF continues to increase based on positive initial outcomes and few intraoperative associated complications. However acute and long-term postoperative complications in skeletally immature patients, such as growth arrest, posttraumatic degenerative arthrosis, and stiffness, are not well known because literature on this topic is lacking.