Objective: This study aimed to analyze the injury pattern and clinical importance of concomitant capitellar cartilage defects (CCDs)among patients treated surgically for radial head fracture (RHF).Methods: A total of 74 patients who were treated surgically for isolated RHFs were retrospectively reviewed. Of these, 12 patients withCCDs (16.2%) were classified as Group I (10 men; mean age, 41.3±12.8 years) and the remaining 62 patients without CCD as Group II(control group) (48 men; mean age, 50.8±13 years). The mean follow-up was 21.3±3.2 months in Group I and 18.7±6.4 in Group II. In GroupI, 11 patients underwent open reduction and internal fixation, whereas 1 patient was treated by radial head resection. The preoperativerange of motion (ROM) was recorded; the severity of RHF was assessed using the Mason classification. The location, size, and thicknessof CCD injuries at the time of surgery were also documented. At the final follow-up, radiological assessment was performed to determinethe bone union, and clinical measurements, including ROM and the Mayo elbow performance score (MEPS), were performed. The clinicalfeatures of the 2 groups were statistically analyzed.Results: In Group I, 10 patients showed limited forearm rotation. CCD was located posterolaterally in 11 patients and anterolaterally in 1patient. At the final follow-up, 11 patients from Group I who underwent open reduction and internal fixation showed complete union ofRHF and full recovery of pronation and supination. According to the MEPS, 9 patients exhibited excellent results, and 3 patients exhibited good results. In Group I, RHFs were classified as Mason type II in 7 patients (58.3%) and type III in 4 patients (58.3%). In Group II,RHFs were type II in 45 patients (72.6%) and type III in 17 patients (27.4%). In comparative analyses, there was a significant difference inage (41.3±12.8 versus 50.8±13.0, p=0.041) between the 2 groups. Preoperative pronation/supination was higher in Group II (131.7±36.2)than in Group I (106.3±31.6) (p=0.021). There were no significant differences in sex (p=0.097), follow-up period (p=0.326), Mason type(p=0.482), preoperative extension/flexion (102.3±43.3 [Group I] versus 107.6±44.9 [Group II]) (p=0.584), final follow-up extension/flexion(133.3±10.7 [Group I] versus 126.9±21.2 [Group II]) (p=0.384), pronation/supination (151.2±9.1 [Group I] versus 151.2±13.3 [Group II])(p=0.558), and the MEPSs (92.9±6.6 [Group I] versus 93.3±7.5 [Group II]) (p=0.701).Conclusion: If a thorough physical examination of a patient with RHF reveals limited forearm rotation, effort must be made to identify thecause, and the possibility of CCD must be considered. Moreover, there is a need for careful observation during RHF surgery for not onlyfracture reduction or fixation but also possible CCD.Level of Evidence: Level III, Therapeutic Study
___
1. Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green’s Operative hand surgery. 7th ed. Philadelphia: Elsevier, 2017, p.734-769.
2. Kaas L, van Riet RP, Vroemen JPAM, Eygendaal D. The incidence of associated fractures of the upper limb in fractures of the radial head. Strategies Trauma Limb Reconstr 2008; 3: 71-4.
3. van Riet RP, Morrey BF, O’Driscoll SW, Van Glabbeek F. Associated injuries complicating radial head fractures: a demographic study. Clin Orthop Relat Res 2005; 441: 351-5.
4. Morrey B, An KN, Stormont TJ. Force transmission through the radial head. J Bone Joint Surg Am 1988; 70: 250-6.
5. Nalbantoğlu U, Gereli A, Kocaoğlu B, Aktaş Ş, Türkmen M. Capitellar cartilage injuries concomitant with radial head fractures. J Hand Surg Am 2008 ;33: 1602-7.
6. Caputo AE, Burton KJ, Cohen MS, King GJ. Articular cartilage injuries of the capitellum interposed in radial head fractures: a report of ten cases. J Shoulder Elbow Surg 2006; 15: 716-20.
7. Madry H, van Dilk CN, Mueller-Gerbl M. The basic science of the subchondral bone. Knee Surg Sports Traumatol Arthrosc 2010; 18: 419-433.
8. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 1954; 42: 123-32.
9. Hotchkiss RN. Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg 1997; 5: 1-10.
10. Ruchelsman DE, Christoforou D, Jupiter JB. Fractures of the radial head and neck. J Bone Joint Surg Am 2013; 95: 469-78.
11. Akesson T, Herbertsson P, Josefsson P-O, Hasserius R, Besjakov J, Karlsson MK. Primary nonoperative treatment of moderately displaced two-part fractures of the radial head. J Bone Joint Surg Am 2006; 88: 1909-14.
12. Herbertsson P, Josefsson P-O, Hasserius R, et al. Uncomplicated Mason type-II and III fractures of the radial head and neck in adults: a long-term follow-up study. J Bone Joint Surg Am 2004; 86: 569-74.
13. Hitzrot JM, Bolling RW. Fractures of the neck of the scapula. Ann Surg 1916; 63: 215-36.
14. Milch H. Unusual fractures of the capitulum humeri and the capitulum radii. J Bone Joint Surg Am 1931; 13: 882-6.
15. Heim U, Trüb HJ. Experiences with primary osteosynthesis in radial head fractures. Helv Chir Acta 1978; 45(1-2): 63-9.
16. Newman J. Radius fractures and damage to the capitulum humeri. Injury 1983; 14(5): 477.
17. Claessen FM, Kachooei AR, Verheij KK, Kolovich GP, Mudgal CS. Outcomes of concomitant fractures of the radial head and capitellum: The “Kissing lesion”. J Hand Microsurg 2016; 8: 100-5.
18. Geel CW, Palmer AK, Ruedi T, Leutenegger AF. Internal fixation of proximal radial head fractures. J Orthop Trauma 1990; 4: 270-4.
19. Michels F, Pouliart N, Handelberg F. Arthroscopic management of Mason type 2 radial head fractures. Knee Surg Sports Traumatol Arthrosc 2007; 15: 1244- 50.
20. Ward WG, Nunley JA. Concomitant fractures of the capitellum and radial head. J Orthop Trauma 1988; 2: 110-6.
21. Itamura J, Roidis N, Mirzayan R, Vaishnav S, Learch T, Shean C. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg 2005; 14: 421-4.
22. Palmer I. The validity of the rule of alternativity in traumatology. Acta Chir Scand 1961; 121: 481-5.
23. Pike JM, Athwal GS, Faber KJ, King GJW. Radial head fractures--an update. J Hand Surg Am 2009; 34: 557-65.