PMC5899880_01
Left elbow before (a) and after (b) attempted closed reduction. Initial injury AP and lateral radiographs (a) demonstrate a radial neck fracture with 20-30  angulation (solid arrows in (a)) and a nondisplaced olecranon fracture (hatched arrow in (a)). Post-closed reduction AP and lateral radiographs (b) are partially obscured by plaster splint but demonstrate no change in alignment of radial neck (solid arrows in (b) compared to (a)).
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fig1
Initial radiographs showed a left radial neck fracture and a nondisplaced olecranon fracture (Figure 1(a)). Follow-up radiographs showed <30  angulation and 1 mm of translation of the radial head (Figure 1(b)).
Left elbow radiographs one (a) and two (b) weeks after injury. One-week AP and lateral radiographs (a) are partially obscured by splint material but demonstrate radial neck fracture with less than 30  of angulation (solid arrows in (a)) and a nondisplaced olecranon fracture (hatched arrow in (a)). Splint was removed and cast placed at one week. Two-week AP and lateral radiographs (b) are partially obscured by overlying cast material but demonstrate no changes from prior radiographs.
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fig2
A long arm cast was placed (Figure 2(a)). Two weeks after injury, left elbow radiographs showed no change in alignment (Figure 2(b)).
Left elbow radiographs three (a), four (b), and eleven (c) weeks after injury. Cast was removed at three weeks. Three-week AP and lateral radiographs (a) demonstrate a radial neck fracture with mild medial displacement and no change in alignment from prior (solid arrows in (a)) and a now-displaced olecranon fracture (hatched arrow in (a)). Four-week AP and lateral radiographs (b) demonstrate increased periosteal reaction about the radial neck fracture (solid arrows in (b)) with no change in alignment from prior and a healing olecranon fracture (hatched line in (b)). Eleven-week AP and lateral radiographs (c) demonstrate increased callus formation and synostosis about the medial aspect of the radial neck fracture (solid arrows in (c)) and a healed olecranon fracture (hatched arrow in (c)).
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fig3
Radiographs demonstrated minimal displacement of the olecranon fracture, but no change in radial neck fracture alignment (Figure 3(a)). Radiographs demonstrated healing radial neck and olecranon fractures (Figure 3(b)). In addition to continued healing of fractures, radiographs demonstrated a new finding of synostosis at the PRUJ (Figure 3(c)).
Left elbow radiographs at two years after injury. Maximum extension and pronation (a) and flexion and supination (b) are shown. On physical examination, she had full range of motion in extension and flexion, but pronosupination was entirely lost. All radiographs show synostosis of the proximal radioulnar joint (solid arrows in (a) and (b)) and fracture deformity from the previously healed proximal radial fracture. The olecranon fracture is healed (hatched arrows in (a) and (b)).
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fig4
Radiographs demonstrated healed radial neck and olecranon fractures, and an extensive bony synostosis at the PRUJ (Figures 4(a) and 4(b)).
Left elbow CT scans (a-c) and CT 3D reconstruction (d-f) at two years six months after injury. Axial (a, b) and sagittal (c) CT views demonstrate synostosis of the proximal radioulnar joint, as do anterior (d), medial (e), and lateral (f) CT 3D reconstruction views (solid white arrows in all). The radial head fracture is healed (hatched white arrows in (d)-(f)). U = ulna; R = radius; O = olecranon; C = cubital fossa.
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fig5
CT scan (Figure 5) confirmed extensive bony synostosis at the proximal radioulnar joint.