Sports injury – radial head fracture

Definition of elbow fractures:

In elbow fractures, the main complication is elbow stiffening with loss of mobility, particularly in extension and supination. Arthroscopic surgery minimizes stiffening by improving the accuracy and efficacy of the repair procedure whilst limiting the trauma of surgery and the ligament lesions that it involves.

Video of elbow fracture treatment:

Video of elbow surgery showing arthroscopic treatment of elbow fracture / Toulouse specialist

Elbow fracture diagnosis:

This preoperative x-ray of the elbow shows a particularly comminuted fracture of the radial head associated with a fracture of the coronoid tip.

Arthroscopic elbow surgery for a fracture of the radial head, preoperative x-ray, ToulouseArthroscopic elbow surgery for a fracture of the radial head, preoperative CT scan, Toulouse

 

Surgical treatment of an elbow fracture:

This difficult elbow surgery is specialized surgery. The surgery is performed on an outpatient basis under regional anaesthesis, with the patient positioned in the lateral decubitus position. Only three 5-mm incisions are necessary.
The evaluation of the lesions is done through the antero-medial optical portal. The surgeon first notices a large intra-articular hematoma in the elbow that impedes vision; it will be removed using a shaver.

Arthroscopic elbow surgery for a fracture of the radial head, anatomy of the elbow, ToulouseArthroscopic elbow surgery for a fracture of the radial head, operative setup, Toulouse

There is a fracture of the coronoid tip, which, one can guess is held by the anterior periosteum. A loose articular foreign body in the form of a cartilage fragment floats freely in the joint of the elbow and can be removed with a shaver. 

Arthroscopic elbow surgery for a fracture of the radial head, removal of the intra-articular hematoma, ToulouseArthroscopic elbow surgery for a fracture of the radial head, extraction of a cartilage fragment, Toulouse

 

 

A heavily comminuted fracture of the radial head is exposed, with loss of osteo-articular material, the annular ligament is intact though and will not require incision.
The elbow fracture is reduced as much as possible using the shaver and probe. Once the best reduction is achieved, the surgeon can check the radial head through the posterior portal.

Arthroscopic elbow surgery for a fracture of the radial head, heavily comminuted fracture of the radial head, ToulouseArthroscopic elbow surgery for a fracture of the radial head, fracture is reduced once smoothened with shaver, Toulouse

 

Shown here is the proximal radio-ulnar joint with the elbow’s lesser sigmoid cavity. The surgeon then places a K-wire (pin) percutaneously under arthroscopic monitoring; it is positioned in the bone, approximately 1.5 mm under the radial head. A compression screw can then be introduced on the guide pin and then screwed until completely buried.

Arthroscopic elbow surgery for a fracture of the radial head, posterior view of the lesser sigmoid cavity, positioning of pin just under the cartilage, ToulouseArthroscopic elbow surgery for a fracture of the radial head, positioning of a compression screw, Toulouse

 

Anterior optical verification confirms reduction quality and stability, with smooth, catching-free pronosupination. The annular ligament stayed intact. The surgical incisions are then closed with absorbable sutures.
The post-operative elbow x-ray shows good fracture reduction with a screw that is perfectly positioned below the articular surface.

Arthroscopic elbow surgery for a fracture of the radial head, verification of reduction and mobility in prono-supination.Arthroscopic elbow surgery for a fracture of the radial head, post-operative x-ray, Toulouse

 

Recovery after elbow fracture surgery

Pain control immobilization will be necessary for 2 to 3 weeks, specific elbow rehabilitation must start immediately. Forceful movements with the elbow must wait at least 2 months.

Arthroscopic elbow surgery for a fracture of the radial head, sport resumes at 2 months, Toulouse