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Chiropractic Journal of Australia : CJA December 2012
Chiropractic Journal of Australia Volume 42 Number 4 December 2012 123 the garden next to the path. He was knocked unconscious by the impact and stopped breathing for 2-3 minutes before regaining consciousness and was taken by ambulance to the emergency room. He suffered from a concussion and fractured several ribs, the right triquetrum and right radial head. The plain film images taken upon admission to the emergency department (Figures 1 and 2) show the comminuted radial head fracture with signifcant displacement of the radial head (see arrow). Figures 3-4 are CT images taken at the time, which reveal the extent of damage of the radial head. Due to the complex nature of the radial head fracture the decision was made by the attending orthopedic surgeon for a radial head replacement (RHR). As the prosthetic implant was not available in the country at the time of injury, the patient was casted for six days, until the prosthesis arrived from overseas and the RHR procedure was performed with no complications. (Figure 5). The patient began upper limb rehabilitation two weeks post surgery and continued for several months. In the fve months following surgery, the elbow motion was initially restricted by a metallic arm brace, which permitted only fexion and extension. Three months later motion was restricted by bandaging during the day and a splint worn at night. The radial head prosthesis prevented the patient from extending his elbow beyond 110º; if elbow extension is forced beyond 110º then elbow dislocation could occur. All ranges of motion of the elbow were slightly reduced; he had 30°-110° fexion-extension (normal 0-140º), 45° pronation (normal 90º) and 60° supination (normal 90º).7 Although the patient had no pain in the elbow, he displayed reduced grip strength of his right hand and atrophy of the right deltoid, supraspinatus, biceps and triceps muscles which all attributed to disuse. Several months into the rehabilitation process, the patient began to develop lower neck pain and sought chiropractic care. The pain could have been a result from the fall itself, or as a result of the biomechanical changes caused by the limited use of his right arm. The patient was under chiropractic care twice a week for three weeks and was adjusted using Diversifed technique throughout the whole spine and pelvis. The patient's neck complaint rapidly improved under chiropractic care and the patient was able to actively participate in his rehabilitation program designed to increase his right arm function and strength. As a result, the patient was very satisfed with his chiropractic care. CASE DISCUSSION OF A RADIAL HEAD REPLACEMENT ONLAND • JIAN Figure 1: AP plain flm elbow showing radial head fracture fragment displaced distally. The radial head has seemed to disappear. There is excessive fragmentation of the head with extreme displacement. (arrow) Figure 2: Lateral plain flm elbow showing the fracture of the radial head with anterior distal displacement of the fracture fragment.
CJA September 2012
CJA March 2013