PMC4708097_01
Initial X-rays in Emergency Department, anteroposterior (A) and lateral (B) views of right elbow showing posterolateral elbow dislocation with radial head fracture.
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Radiographic examination of the right elbow showed posterolateral elbow dislocation with radial head fracture (Figure 1A, 1B).
Initial x-rays in Emergency Department, anteroposterior (A) and lateral (B) views of right wrist showing comminuted fracture distal radius.
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Wrist radiographs showed a dorsally displaced metaphyseal distal radius fracture with mild metaphyseal comminution and ulnar styloid fracture (Figure 2A, 2B).
Intraoperative anteroposterior (A) and lateral (B) wrist views under image intensifier showing fracture distal radius, middle third scaphoid, and ulnar styloid tip.
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Examination of the wrist under I I revealed a middle third scaphoid fracture (Figure 3A, 3B), which was missed in the initial assessment in ER, in addition to the distal radius fracture with the tip of ulnar styloid fracture.
Intraoperative anteroposterior elbow view under image intensifier showing radial head fracture.
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The fractured radial head-piece was excised (Figure 4), as it was a thin osteocartilaginous piece that was difficult to stabilize.
Anteroposterior (A) and lateral (B) elbow views showing congruent elbow joint reduction, post repair of the lateral collateral ligament, extensor origin, and excision of the radial head fragment.
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The LCL and the extensor origin were repaired using suture anchors (GII Quick Anchor plus, DePuy Synthes, Mitek Sport Medicine) (Figure 5A, 5B).
Anteroposterior (A) and lateral (B) wrist views showing healed distal radius and scaphoid fractures. Note: the ulnar styloid was not stabilized.
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The scaphoid was stabilized with a mini screw (2.4 mm Cortex Screw, DePuy Synthes) (Figure 6A, 6B); the distal radioulnar joint was found stable so it was decided not to stabilize the ulnar styloid fracture.
Clinical appearance of right upper limb range of motion 16 months postoperatively showing excellent range of motion; elbow extension (A) and flexion (B), wrist dorsiflexion (C) and palmar flexion (D), forearm supination (E) and pronation (F).
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The patient was followed up for about 18 months, during which he regained almost near normal range of motion compared to the normal side (Figure 7A-7F].