Elsevier

The Journal of Hand Surgery

Volume 33, Issue 9, November 2008, Pages 1602-1607
The Journal of Hand Surgery

Scientific article
Capitellar Cartilage Injuries Concomitant With Radial Head Fractures

https://doi.org/10.1016/j.jhsa.2008.05.016Get rights and content

Purpose

To evaluate the incidence and types of capitellar cartilage injuries associated with higher-grade radial head fractures.

Methods

Fifty-one consecutive patients with operatively treated, unstable, displaced Mason type II to III radial head fractures were identified. Ten of 51 patients had capitellar cartilage injuries concomitant with these fractures. All cartilage injuries were identified at the time of surgery except in 1 patient whose injury was determined via computed tomography. There were 8 men and 2 women with an average age of 33 years (range, 24–39 years). Lesions were seen with direct inspection and recorded by location, size, and thickness.

Results

The incidence of capitellar chondral lesions concomitant with operatively treated Mason type II to III radial head fractures appeared in 10 of 51 patients. The average size was 5 × 5 mm (range, 2 × 2 mm to 10 × 10 mm). Four patients had Mason type II and 6 had Mason type III radial head fractures. The average surface of the cartilage injury was 6 × 7 mm (range, 3 × 6 mm to 10 × 10 mm) for Mason type II fractures and 4 × 4 mm (range, 2 × 2 mm to 5 × 10 mm) for Mason type III fractures. Two Mason type III fractures had full-thickness cartilage lesions, and 4 Mason type III fractures had partial-thickness cartilage lesions. Two Mason type II fractures had full-thickness cartilage lesions and the other 2 had partial-thickness cartilage lesions.

Conclusions

Capitellar cartilage lesions frequently occurred concomitantly with higher-grade radial head fractures. The incidence of these lesions increased with greater severity of radial head fractures. Low-grade radial head fractures created higher-grade cartilage lesions as the intact radial head can cause more damage to the capitellum. Careful evaluation of the joint should be performed for these subtle injuries.

Type of study/level of evidence

Prognostic IV.

Section snippets

Materials and Methods

Fifty-one consecutive skeletally mature patients with unstable, displaced Mason type II to III radial head fractures11 operatively treated at our clinic between 1999 and 2006 were identified. There were 23 patients who had type II and 28 patients who had type III radial head fractures. All type II and III radial head fractures were treated surgically in this period. Relative to the total number of operatively treated radial head fractures during the study period, 10 patients were identified

Results

The incidence of capitellar cartilage injuries in 51 operatively treated Mason type II to III radial head fractures was 10 in this study. All cartilage injuries were located at the inferolateral side of the capitellum. The average size of the cartilage lesion was 5 × 5 mm (range, 2 × 2 mm to 10 × 10 mm) (Table 1). There were 6 partial-thickness cartilage injuries determined, and debridement of loose edges was applied. There were 4 full-thickness cartilage injuries determined (Table 1). In 2 of

Discussion

Radial head fractures may be complicated by the presence of associated lesions. One of the less-recognized is trauma to the capitellum.6, 8, 10, 14 These lesions are not always appreciated because of the focus on the radial head, but the capitellum is at risk because of reciprocal impinging on the radial head.9 This can be explained by the importance of the radiocapitellar contact surface: 60% of the axial load at the elbow is transmitted through the radiocapitellar joint.15 The capitellum is

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Copyright © 2008 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.