What is the recommended treatment for an acute intraarticular fracture of the radial head with 2mm diastasis and cortical evulsion fracture of proximal ulna, supinator crest at the attachment of the lateral ulnar collateral ligament?

Treatment of Acute Intraarticular Radial Head Fracture with Ulnar Collateral Ligament Avulsion

For an acute intraarticular radial head fracture with 2mm diastasis and cortical avulsion fracture of the proximal ulna at the lateral ulnar collateral ligament attachment, surgical management is recommended to restore joint stability and function. 1, 2

Classification and Assessment

• This injury represents a complex fracture pattern involving both the radial head and proximal ulna with ligamentous involvement, which requires careful evaluation 2
• The radial head fracture can be classified as a Mason type 2 fracture (displaced intraarticular fracture with >2mm diastasis) 1
• The associated ulnar avulsion fracture at the lateral ulnar collateral ligament (LUCL) attachment indicates potential instability of the elbow joint 2, 3

Treatment Recommendations

• Surgical management is indicated due to:

  • Intraarticular involvement with 2mm displacement (diastasis) of the radial head fracture 1
  • Associated avulsion fracture of the proximal ulna at the LUCL attachment, suggesting ligamentous instability 2, 3

• For the radial head component:

  • Open reduction and internal fixation (ORIF) is recommended for the displaced radial head fracture to restore joint congruity and stability 1, 4
  • If the fracture is amenable to fixation (limited comminution), preservation of the native radial head is preferred over radial head replacement 3
  • Radial head replacement should be considered if comminution prevents stable fixation 1, 3

• For the ulnar avulsion component:

  • Fixation of the ulnar avulsion fracture is necessary to restore LUCL function and lateral stability 2, 3
  • This can typically be accomplished with small fragment screws or suture anchors 2

Postoperative Management

• Early protected range of motion exercises should be initiated following stable fixation to prevent stiffness 5
• Active finger motion exercises should be performed to prevent stiffness, which is one of the most functionally disabling adverse effects of upper extremity fractures 6
• Early wrist motion is not routinely necessary following stable fracture fixation 6

Potential Complications

• Failure to address both components of this injury can lead to:
  • Chronic elbow instability, particularly in rotation 3
  • Proximal migration of the radius 3
  • Chronic wrist pain due to distal radioulnar joint dysfunction 3
  • Joint stiffness and limited range of motion 5, 1

Important Considerations

• Restoration of radial length is critical to prevent proximal migration of the radius and subsequent wrist complications 3
• The timing of surgical intervention is important - optimal results are achieved when definitive treatment is performed within one week of injury 3
• Careful assessment of the distal radioulnar joint is recommended in all patients with radial head fractures to rule out associated injuries 3
• Radial head excision alone is contraindicated in this injury pattern due to the risk of instability and proximal radial migration 3