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Case Report

An isolated posterior dislocation of radial head inadults e A rare injury: A case report

A.P. Singh a,f, V. Garg b,*,f, R. Vaishya c,f, A.P. Singh d,f, R. Raman e,f

a Consultant Orthopaedic Surgeon, Punjab Civil Medical Services-1, Mukerian,

Punjab 144211, Indiab Fellow Arthroscopy, ISKSAA, Dept of Orthopedics, Delhi 110034, Indiac Professor Orthopedics, Indraprastha Apollo Hospitals, New Delhi 110076, Indiad Consultant Orthopedics, Kanwar Hospital and Research Centre, Hajipur, Hoshiarpur,

Punjab 144211, Indiae Consultant Orthopedic, Vardhman Govt. Medical College, West Bengal 713144, India

a r t i c l e i n f o

Article history:

Received 2 April 2014

Accepted 7 May 2014

Available online xxx

Keywords:

Radial head fracture

Post dislocation elbow

Monteggia fracture

Radial head fixation

* Corresponding author.E-mail address: vip.ucms@gmail.com (V.

f Source e Kanwar Hospital and Research

Please cite this article in press as: SinghAreport, Apollo Medicine (2014), http://dx.

http://dx.doi.org/10.1016/j.apme.2014.05.0110976-0016/Copyright © 2014, Indraprastha M

a b s t r a c t

An isolated posterior dislocation of radial head in adults is a rare injury. We report a 32-

year-old male patient with posterior dislocation of radial head associated with articular

fracture fragment of the radial head. Open reduction and internal fixation with a minis-

crew was done and patient had excellent outcome at a follow up of 2 years.

Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

1. Introduction

Isolated posterior dislocation of radial head is a rare injury

especially in skeletally mature individuals.1 Usually posterior

dislocation of radial head is common in children and is

considered under the monteggia variant. Earlier reports of

cases of acute radial head dislocation in adults have been

associated with either ulna fracture or elbow dislocations.2

Garg).Centre, Hajipur, Hoshiar

P, et al., An isolated postdoi.org/10.1016/j.apme.2

edical Corporation Ltd. A

2. Case report

A 32-year-old male presented with painful left elbow held in

slightly flexed and supinated position in the emergency room.

He had a history of fall on his non-dominant left hand.

Swelling was obvious on lateral and posterior aspect of elbow.

On examination all rotatory movements were restricted and

painful. There was no tenderness on medial side of elbow,

pur, Punjab, India.

erior dislocation of radial head in adultseA rare injury: A case014.05.011

ll rights reserved.

Fig. 1 e AP radiograph pre-operative.

a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1e32

forearm or distal radioulnar joint. Neurovascular examination

was within normal limits.

Radiographs of elbow showed posterior radial head dislo-

cation with intra-articular fracture fragment of radial head

displaced superiorly (Figs. 1 and 2). There was no other asso-

ciated bony injury.

Fig. 3 e AP radiograph post-op.

3. Surgical technique

Patient was taken for open reduction and exploration of the

joint. Kocher approach with proximal extension was used

with careful dissection to preserve the soft tissue attachment

of the fractured fragment. Annular ligament was torn. Radial

head was lifted anteriorly by pressure of small Hohmann re-

tractors placed subperiosteally. Radial head articulation with

capitellum was confirmed. A 1.5 mm Kirschner wire (K-wire)

was used to temporarily fix the articular fragment. A 2.7 mm

miniscrew (Max ortho, Bombay, India) was used to fix the

fractured fragment and articular congruity and stability was

confirmed. Thorough joint lavagewas done. Annular ligament

was reconstructed. A 2 mm K-wire was used to fix the radio-

capitellar joint in neutral position of forearm. The K-wire was

removed at 2 weeks and flexion extension movements of the

elbow were initiated. Rotatory movements were started at 3

weeks. At 8 weeks light weight lifting was allowed. After a

Fig. 2 e Lateral radiograph pre-operative.

Please cite this article in press as: SinghAP, et al., An isolated postreport, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2

follow up of 2 years the patient had 0e110� of movement with

full pronation and supination (Figs. 3 and 4).

4. Discussion

Isolated dislocation of the radial head without concomitant

ulnar fracture or humeroulnar subluxation in adults is a rare

injury.1,3e7 Most of the earlier reported cases were in children

and were considered monteggia variants.2

Fig. 4 e Lateral radiograph post-op.

erior dislocation of radial head in adultseA rare injury: A case014.05.011

a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1e3 3

Heidt and Sterne, in 1982, were the first to describe this

injury.1 Only 20 cases have been reported in adults in the

literature,6 but we were not able to find any case in literature

where posterior dislocation is associated with intra-articular

fracture of radial head.

The mechanism leading to an isolated radial dislocation

has been variously described. Most authors describe an indi-

rect mechanism. The proximal radioulnar joint is most stable

in supination: in this position, the contact between radius and

ulna is maximal and the interosseousmembrane, the annular

ligament, and the anterior fibres of the quadrate ligament are

all taut, thus drawing the radial head snugly against its notch

in the ulna. Cadaveric studies have shown that posterior

dislocation of the radial head cannot occur without the

rupture of the annular ligament; in addition, partial tear of the

quadrate ligament and the proximal interosseous membrane

takes place. We speculate the mechanism in our patient to be

a hyperextension of the elbow with forearm in prone position

leading to a posterior dislocation of the radial head.

There are no guidelines for treatment. Most of these cases

with isolated posterior radial head dislocation were treated

conservatively except two cases.6,7 In one case open reduction

was performed due to soft tissue interposition6 and in second

one open reduction was done because of persistent instability

of radial head and annular ligament reconstruction was

done.7 In our case we reconstructed radial head and annular

ligament and radio capitullar K-wire was applied for 2 weeks.

Most of these reported cases showed excellent result

following prompt diagnosis and reduction. Hence it is very

necessary to identify these injuries as soon as possible and

treat them promptly especially when associated with intra-

articular fractures.

Please cite this article in press as: SinghAP, et al., An isolated postreport, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2

The recognition of such injuries is of paramount impor-

tance to prevent early degenerative arthritis of elbow. In our

case we found that open reduction and internal fixation of

posterior radial head dislocation with articular fracture yields

excellent results.

Conflicts of interest

All authors have none to declare.

r e f e r e n c e s

1. Heidt Jr RS, Stern PJ. Isolated posterior dislocation of theradial head. A case report. Clin Orthop Relat Res. 1982;168:136e138.

2. Bado JL. The monteggia lesion. Clin Orthop. 1967;50:71e78.3. Negi AK, Pestonji MD, Iyer S. Isolated posterior dislocation of

the radial head in an adult. J Postgrad Med. 1992;38:143.4. Ibrahimi AE, Shimi M. Isolated, traumatic posterior dislocation

of the radial head in an adult: a new case treatedconservatively. J Emerg Trauma Shock. 2010OcteDec;3(4):422e424.

5. Bonatus T, Chapman MW, Felix N. Traumatic anteriordislocation of the radial head in an adult. J Orthop Trauma.1995;9:441e444.

6. Takami H, Takahashi S, Ando M. Irreducible isolateddislocation of the radial head. Clin Orthop Relat Res.1997;345:168e170.

7. Dhawan A, Hospodar PP. Isolated posttraumatic posteriordislocation of the radial head in an adult. Am J Orthop.2002;31:83e86.

erior dislocation of radial head in adultseA rare injury: A case014.05.011

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