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Complex Radial Head Fracture with Soft Tissue Defect from Low-Velocity Gunshot Wound
Score and Comment on this Case
Clinical Details
Clinical and radiological findings: The patient sustained a low-velocity gunshot wound to the elbow, resulting in a complex fracture of the radial head with significant soft tissue injury. Radiographic evaluation revealed a simple split fracture of the radial head with minimal neck available for fixation. The injury was classified as an AO/OTA 21-B2 fracture. The soft tissue defect was extensive, necessitating careful consideration of grafting options.
Preoperative Plan
Planning remarks: The preoperative plan involved an open reduction and internal fixation (ORIF) using a bridge plate combined with an intramedullary (IM) nail for stability. The approach aimed to achieve immediate postoperative motion, particularly pronation and supination, while minimizing the risk of early mechanical failure.
Surgical Discussion
Patient positioning: The patient was positioned supine on the operating table with the affected arm placed on a radiolucent hand table to allow for optimal access and imaging during the procedure.
Anatomical surgical approach: A lateral approach to the elbow was utilized, with careful dissection through the soft tissue layers to expose the radial head. The entry wound was debrided, and the fracture site was accessed for reduction and fixation.
Operative remarks:The surgeon noted the limited real estate for fixation of the radial head segment, which required interfragmentary fixation of the split fracture. Due to the minimal neck available, three to four locked 2.4mm screws were used in conjunction with a 2.0 or 2.4 T plate functioning as a bridge plate. An IM nail was employed to augment stability and protect against early fatigue failure of the plate. Given the extensive soft tissue injury, acute grafting was deferred in favor of a staged approach.
Postoperative protocol: Postoperative rehabilitation focused on immediate range of motion exercises, particularly emphasizing pronation and supination, while weight-bearing activities were restricted until adequate healing was confirmed.
Follow up: Not specified
Orthopaedic implants used: 2.4mm locking screws, 2.0 or 2.4 T bridge plate, intramedullary nail
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User Discussion (1)
Guest User
excellent primary fixation. Can I ask- 1. Which nail did you use and is any part of distal nail exposed or completely embedded in the bone(How easy will it be to remove?) 2. When did you the second stage. I am assuming you are planning to do Masquelet here and what was the outcome? Thanks