Radial Head Fractures: MRI Evaluation of Associated Injuries

Author(s): Itamura, J., Nikolaos, R., Mirzayan, R., et. al.

Source: Journal of Shoulder and Elbow, Volume 14:(4)

Summary:

This is a retrospective study performed on twenty-four consecutive patients with acute Mason Type II and III radial head fractures.  The authors evaluated each patient with standard radiographs, physical examination and  MRI evaluation with the elbow at 90 degrees of flexion in order to identify additional  bony or ligamentous injuries.  The MRIs were evaluated by a musculoskeletal radiologist blinded to the patient’s plain radiographs.   The observers were asked to make an assessment of the integrity of the medial and lateral collateral ligament.  In addition, they were asked to remark on any capitellar osteochondral defects, bone bruises, or loose bodies.  Intra- and inter-observer variability was also recorded.  The authors conclude that disruption of the medial collateral ligament occurred in fifty-four percent, that the lateral ulnar collateral ligament was disrupted in eight percent.  Both ligaments were disrupted in fifty percent of patients.  They conclude that capitellar osteochondral lesions occurred in thirty percent of patients, and loose bodies were present in ninety-two percent of individuals.

The results of this study indicate that radial head fractures, which may initially be felt to be uncomplicated displaced or comminuted intra-articular fractures, have a significant association with ligamentous and osteochondral lesions, which have implications on the prognosis and appropriate treatment. This is particularly important in light of the current controversy surrounding the indications for radial head arthroplasty

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Journal of Shoulder and Elbow