Simultaneous ipsilateral distal radius and radial head fractures

Abstract

Rationale: Distal radius fracture with simultaneous ipsilateral radial head fracture is a very rare pattern of injury. This type of injury is referred to as ‘radius bipolar fracture’. Treatments for this injury pattern can be challenging because both the wrist and elbow need to be considered. There are currently no guidelines for the treatment of this specific type of injury. We report two cases of this unusual pattern of injury treated in our hospital. Patient concerns: Case 1 was a 78-year-old female patient and case 2 was a 19-year-old female patient who visited our emergency department with left elbow and wrist pain after slipping and falling. Diagnosis: Plain radiography and computed tomography revealed radius bipolar fracture. Case 1 had an AO type C3 distal radius fracture, a Mason type III radial head fracture. Case 2 had an AO type B2 undisplaced distal radius fracture and a Mason type III radial head fracture. Interventions: In case 1, open reduction and internal fixation (ORIF) was performed for the distal radius fracture and radial head replacement arthroplasty for the radial head fracture. In case 2, distal radius fracture was treated conservatively and ORIF was performed for the radial head fracture. Outcomes: Bony union as achieved in both cases. At 1-year follow-up, case 1 showed slight limited range of motion of the wrist. Case 2 showed no radius shortening and full range of motion of the wrist and elbow. The Quick disabilities of the arm, shoulder and hand score was 18 and 16, respectively. Lessons: After this type of injury, the radius length can be changed, and as a result, ulnar variance can be affected. When radial head replaced is considered, it would be better to operate on the wrist first, and then perform radial head replacement. In this way, radiocapitellar overstuffing or instability can be prevented. However, if ORIF is planned for proximal radius fracture, either the proximal or distal radius can be fixed first. Surgeons should try to preserve radial length during treatment to optimize patient outcomes.

Rare triad of fractures in the upper limb. Simultaneous fractures of the distal radius, with the radial head and the ulna styloid

“…In our patient, an open reduction internal fixation was done to the right distal radius. Il-Jung Park [10] stated that fixation of the distal radius allows for the restoration of radial length and prevents instability or radiocapitellar overstuffing. The study recommended operation on the wrist first, followed by performing the radial head replacement.…”

“…There are no best practice guidelines for the treatment of ipsilateral proximal and distal fracture ends of radius. Il-Jung Park [10] study provided recommendations for treating a similar condition. Their study stated that the radial length should be taken into consideration.…”

“…Consideration towards the elbow and the wrist should be taken in surgery and postoperative care as complications such as fracture collapse or metal failure may arise due to early rehabilitation. At the same time, prolonged immobilization may cause arthritic changes or joint contractures [10] .…”

A rare triad of fractures in the upper limb. Simultaneous fractures of the distal radius

“…There are no best practical guidelines for the treatment of ipsilateral proximal and distal fracture ends of radius. Il-Jung Park [10] study provided recommendations for treating a similar condition. Their study stated that the radial length should be taken into consideration.…”

“…Consideration towards the elbow and the wrist should be taken in surgery and postoperative care as complications such as fracture collapse or metal failure may arise due to early rehabilitation. At the same time, prolonged immobilization may cause arthritic changes or joint contractures [10]. Patients may experience arthritic changes or joint contracture due to long periods of immobilization [11].…”