Nur Azuatul Akma Kamaludin,Nur Azree Ferdaus Kamudin,Shalimar Abdullah,Jamari Sapuan.[J].中华创伤杂志英文版,2019,22(1):59-62
Ipsilateral proximal and distal radius fractures with unstable elbow joint: Which should we address first?
  
DOI:10.1016/j.cjtee.2018.04.007
KeyWord: Simultaneous ipsilateral fracturesRadius fracturesIrreducible elbow dislocationRadial headRadial head arthroplasty
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Author NameAffiliation
Nur Azuatul Akma Kamaludin Department of Orthopaedics & Traumatology, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia 
Nur Azree Ferdaus Kamudin Department of Orthopaedics & Traumatology, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia 
Shalimar Abdullah Department of Orthopaedics & Traumatology, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia 
Jamari Sapuan Department of Orthopaedics & Traumatology, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia 
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Abstract:
      Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an anatomical locking plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.
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