PMC4601955_01
CT scan following closed reduction. A: Sagittal view through the radiocapitellar joint revealing a comminuted, displaced radial head fracture. B: sagittal view through the ulnohumeral joint showing a coronoid tip fracture, type I according to Regan and Morrey.
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Plain radiography and a subsequently performed computer tomography (CT) scan revealed a terrible triad injury with posterior dislocation of the elbow joint, a severely comminuted radial head fracture and a coronoid tip fracture, type I according to Regan and Morrey (Fig. 1).
Overstuffing of radial head replacement. A: CT scan in sagittal view 10 months postoperatively revealing overstuffing with capitellar erosion. B: intraoperative view through a lateral Kocher approach. The head of the bipolar prosthesis has been removed to show the damage of the capitellar cartilage (arrows).
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Plain radiography and a CT scan revealed overstuffing of the radial head arthroplasty which led to erosion of the capitellar cartilage (Fig. 2).
Preoperative CT scan prior to radiocapitellar arthroplasty. Congruent ulnohumeral joint space without signs of significant osteoarthritis.
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Since significant osteoarthritis of the ulnar column was not present (Fig. 3), radiocapitellar arthroplasty was performed three years after the initial trauma (surgeon: SL).
Intraoperative view during diagnostic arthroscopy showing progressive osteoarthritis of the ulnar column. A: through a mid-triceps portal the olecranon tip (OL) and dorsal part of the trochlea (TR) can be visualized. B: with an arthroscopic shaver the olecranon tip (OL) is pulled back to expose the severely damaged trochlear cartilage. C/D: dorsal view of the correctly implanted radiocapitellar replacement in flexion (C) and extension (D). RH = Radial head, CAP = Capitulum.
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Diagnostic elbow arthroscopy one year after radiocapitellar arthroplasty revealed now severe osteoarthritis of the ulnohumeral joint (Fig. 4).
Chronological sequence. A: radiographs immediately following trauma revealing a terrible triad injury. B: initial overstuffing of the radial head replacement. C: revision and correct placement of the radial head replacement (10 months following trauma). D: progressive capitellar erosion with narrowing of the radiocapitellar joint space (17 months following trauma), E: radiocapitellar replacement (36 months following trauma), F: total elbow replacement (48 months following trauma).
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He was satisfied with the result of the surgery as he was free of pain at rest for the first time since the accident (Fig. 5).