PMC6218754_01
Plain radiographs showing posterior elbow dislocation with displaced radial head.
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The X-rays showed the posterior elbow dislocation with displaced radial head fracture (Figure 1).
CT scan showing the coronoid tip fracture (yellow arrow) and irreparable radial head fracture with indented articular surface (blue arrow) and deformation of the fracture ends (white arrow).
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A tip fracture of the coronoid process (Reagan-Morrey type I) was noted (Figure 2).
Preoperative planning: (a) 3D registration of the affected side with the mirrored image of the contralateral side and (b) planned level of bone resection and extent of radial head reconstruction.
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Subsequently, 3D image of the affected side was aligned with the mirrored 3D image of the contralateral bone by registration of the radial tuberosity and diaphysis to identify the correct anatomic profile of the reconstructed part (Figure 3(a)). With this technique, accurate preoperative planning for the position of additional bone resection and extent of radial neck restoration can be established (Figure 3(b)).
Photographs of titanium prosthesis with impressed mark (yellow arrowhead) to guide the rotation alignment.
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Note that the impressed mark in line with the radial tuberosity was specifically designed on the surface of the prosthesis to guide for the rotation alignment (Figure 4).
Photographs of 3D resin models of the proximal radius representing the cutting line and location of the impressed (blue arrow) for intraoperative guidance.
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The 3D resin models of the proximal radius representing the cutting line were also fabricated using the 3D printing technique for intraoperative guidance (Figure 5).
Intraoperative photograph showing the congruity of the titanium prosthesis with the sigmoid notch.
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The radial head prosthesis was introduced into the canal with the impressed mark aligned with radial tuberosity until the prosthetic neck fully seated on the cutting cortex (Figure 6).
Postoperative range of motion at 24 months after the surgery.
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At the latest follow-up, 24 months after surgery, the elbow extension was 28 , flexion was 145 , pronation was 80 , and supination was 90  (Figure 7).
Postoperative plain radiographs at the last follow-up.
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The proximal bone resorption at the radial neck and capitellar osteopenia were observed (Figure 8).