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Chiropractic Journal of Australia : CJA December 2012
122 Chiropractic Journal of Australia Volume 42 Number 4 December 2012 INTRODUCTION The elbow is a relatively stable joint, composed of a secure synovial hinge joint of the olecranon process of the ulna that articulates with the trochlea of the humerus thus permitting large ranges of fexion and extension. There is virtually no lateral fexion due to this tight bony articulation. The radial head which articulates with the capitulum permits supination and pronation. Muscle groups such as the biceps brachii, triceps brachii, the wrist fexors and extensors all cross the elbow in various anatomic distributions and substantially aid the stability of the joint. Fractures of the elbow are common and typically result from a fall on an outstretched hand (FOOSH) injury, where the force is distributed through the wrist, to the elbow and then on to the shoulder girdle. The most common fracture of the elbow in children is a supracondylar humeral fracture, accounting for over 60% of pediatric elbow fractures.2 In adults, the most common elbow fractures are of the radial head or neck, which together account for approximately 50% of adult elbow fractures with the radial head accounting for 33% of all elbow fractures.2,3 The FOOSH mechanism of injury is a common cause of radial head fractures because it involves a compressive force that is transferred through the elbow, impacting the radial head.4-9 Joyce Onland, B Chiro, Resident in Diagnostic Imaging, New Zealand College of Chiropractic Lisa Jian, B Chiro, Resident in Diagnostic Imaging, New Zealand College of Chiropractic Department of Diagnostic Imaging, New Zealand College of Chiropractic Received: 28 May 2012, accepted with minor revisions: 24 June 2012 Post Traumatic Radial Head Replacement in a 56 year-old Male: A Radiology Case Report JOYCE ONLAND and LISA JIAN ABSTRACT: Objective: To discuss a post traumatic radial head replacement in a 56 year-old male and note the role chiropractic care played in his management. Clinical features: The patient presented to a chiropractic offce with a neck complaint. Case history revealed a fall 4 meters off a roof where the patient was knocked unconscious and fractured several ribs, the right triquetrum and right radial head. The extensive elbow injury was treated with a radial head replacement (RHR) and upper limb rehabilitation. The radial head prosthesis prevents extension of the patient's elbow beyond 110º; he also had slight reduction in all other elbow ranges of motion. He displayed reduced grip strength and atrophy of major muscle groups of the involved upper extremity. He was managed concurrently by his chiropractor to address the neck complaint associated with the biomechanical changes caused by the upper extremity injury. Conclusion: Due to the complex nature of the radial head fracture, RHR replacement was chosen to maintain the integrity and stability of the elbow joint. INDEX TERMS: (MESH): ADULT; RADIUS FRACTURE; RADIOLOGY; TRAUMA. (Other) : FOOSH; RADIAL HEAD REPLACEMENT; RADIAL HEAD FRACTURE. Chiropr J Aust 2012;42: 122-5. In most FOOSH injuries the fall is typically from a standing position height, but it is unusual for the height to be over a meter or two. This case is a rare example of a patient who fell from four meters, a height that is rarely seen, and resulted in a comminuted displaced (shattered) radial head. (See fgures 1-5). In cases of trauma to the elbow with resultant radial head fracture, appropriate identifcation, classifcation and treatment of the fracture is vital for the long term preservation of elbow stability and function.7 In cases of complex radial head fractures, where there is extensive fragmentation and/ or associated dislocation of the radial head, the chances of conservative management or open reduction internal fxation (ORIF) having a positive outcome is reduced, making a radial head replacement (RHR) a more appropriate management strategy.9 With RHR there is a prolonged post-operative rehabilitation process to ensure ongoing function for the patient and to return them to their pre-injury state. Patients can present for concurrent chiropractic care, however, there needs to be some modifcations made by the chiropractor, such as how they position the patient and possibly technique selection. CASE HISTORY In this case, a 56 year-old male presented to a chiropractic offce with chronic neck pain as a result of a signifcant injury he sustained several months prior. His complaint may have been directly associated with the fall itself or from the complex post injury changes in upper limb function. The patient was spraying a mould remover on his roof at home, when he slipped on the wet roof and fell to the ground four meters below. As he fell he extended his arm and landed onto the brick garden path with his head hitting the soil of
CJA September 2012
CJA March 2013