To a line bisecting the radial head in the anteroposterior (AP) plane. The interval for more distal dissection should be just anterior The extensor carpi radialis, elevates it, and incises the underlyingĮlbow capsule, it is then possible to see the capitulum and radial Supracondylar ridge of the distal humerus, if one incises the origin of Interval and protecting the lateral collateral-ligament complex wasĭescribed by Hotchkiss ( 22): Starting at the I find these intervals difficult to define precisely based upon Kaplan described an interval between the extensor carpi radialis brevis and the extensor digitorum communis ( 54), whereas Hotchkiss recommends going directly through the extensor digitorum-communis muscle (see Fig. Some authors recommend identifying the nerve if dissection onto the radial neck is required ( 22). Intraoperative evidence of ligament injury shouldĪlways be sought ( 53), particularly if simple excision is being considered ( 22).Ī more anterior interval protects the lateralĬollateral-ligament complex but places the posterior interosseous nerveĪt greater risk ( 22). As has been emphasized by Davidson et al ( 36),Ĭomplex fractures of the radial head are nearly always associated withĪ complex injury. 9.1C) and (e) posterior olecranon fracture-dislocations (posterior Monteggia pattern injuries) (see Fig. 9.1B) (c) fracture of the radial head and posterior dislocation of the elbow ( 47, 48) (d) posterior dislocation of the elbow with fractures of the radial head and coronoid process ( 18, 29, 48) ( Fig. 9.1A) ( 27, 37, 38) (b) fracture of the radial head and rupture of the medial collateral-ligament complex and/or fracture of the capitulum (see Fig. The forearm (Essex-Lopresti and variants) ( Fig. In my experience in both patient care and research,įractures of the radial head can occur either in isolation or inĪssociation with one of several discrete injury patterns, including (a)įracture of the radial head and rupture of the interosseous ligament of Plain radiographs are useful for determining the overall Radial-head prosthesis for complex fractures of the radial head ( 19, 20), the role of ORIF is being redefined. Rotation after operative fixation ( 9, 16, 17, 18).Ĭombined with increased availability and use of more-predictable metal Radial head are prone to early failure, nonunion, and poor forearm Some subsequent reports have stated that complex fractures of the Isolated, partial, radial-head fractures for which good results would Head fractures were very positive, perhaps due to the prevalence of As a result, and also due to the inadequacy and problems associated with the silicone rubber radial-head prostheses ( 2, 6, 7, 8), it became popular to attempt to save even the most complex fracture of the radial head by operative fixation ( 9).Įarly reports of open reduction and internal fixation (ORIF) of radial ![]() ![]() The advent of techniques and implants for internal fixation of small fractures ( 1)Ĭoincided with an increasing appreciation of the importantĬontributions of the radial head to the stability of the elbow andįorearm ( 2, 3, 4, 5).
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