Presentation
The patient admitted to the ER reporting a fall from height during an assault, presenting with deformity and pain in her right elbow.
Patient Data
AP and lateral radiographs of the elbow reveal elbow dislocation with a posterolateral displacement of the radius and ulna with an intra-articular radial head fracture. The elbow joint effusion was identified by dorsal displacement of the posterior fat pad and the sail sign, representing an anterior fat pad elevation.
Impression: The findings are indicative of a Mason-type 4 injury.
AP and lateral radiographs after reduction of elbow displacement. Intra-articular radial head fracture.
Impression: Intra-articular radial head fracture.
CT demonstrates a mildly displaced intra-articular comminuted fracture of the radial head and neck, with more than 2 mm articular step-off (fracture gap). There is joint effusion (hemarthrosis).
Impression: the CT analyzed in combination with the x-ray is consistent with a Mason-type 4 fracture.
Case Discussion
Radial head fractures account for one-third of elbow fractures in adults. CT helps to distinguish the type of fracture based on Mason classification. Treatment depends on the fracture type and the functional range of motion. Conservative treatment is usually recommended for type 1 and type 2 fractures with a preserved range of motion. Surgery is for type 2 fractures with a low range of motion and does not respond to conservative treatment, and all types 3 and 4 fractures 1-4.
This case is a typical example of a displaced fracture of the radial head, associated with elbow joint dislocation (Mason type 4). The treatment of this patient was surgery with internal fixation.
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