Date: Mon, 3 Jul 2000 19:24:02 +0100

From: samir chhabra

Subject: Displaced radial head fracture

A 29 year old rt handed lorry driver and deliverer of heavy parcels had a fracture of his left radial head 3 weeks back.

At 7 days following the injury

Symptoms: pain, and restriction of movement. He also had discomfort at the distal radioulnar joint though there was no clinical or radiological evidence of DURJ subluxation. Following a local anaesthetic  injection in the elbow the pain disappeared but his forearm remained in neutral position with 15 deg. of supination and 20 degrees of pronation.

AP	Lateral

I did an open reduction and Herbert screw fixation. On table before opening the # there was a block to pronation and supination to the same extent as noticed preop. (Post op films:radial head2)

Postop lateral

One week following surgery:

His pain returned and again could not move his forearm at all, stuck in neutral position. Repeat x-rays confirmed the suspicion that the fixation had failed and the fragment had displaced again. His pain at the DURJ has subsided.

1 week postop

What do I do now?????

According to myself, my options are:

• 1. Attempt at refixation. This could be difficult, and if fails again ... more trouble.
• 2. Replacement. A vitallium one. But considering the fact that he is young and involved in heavy labour, problems with the implant are high.
• 3. Excision. I think chances of chronic pain at the DURJ are high as this a type of Essex lopresti injury.

Please advise,

Samir Chhabra