Chondral lesion of the capitellum humeri accompanying a radial head fracture: A case report

Abstract

In this case report we present a case of a full thickness chondral lesion of the anterior-distal surface of the capitellum humeri, accompanying an intraarticular radial head fracture. The importance of this case is the resemblance of the chondral injury to a Lorenz-Kocher lesion of the humerus and atypical displacement of chondral fragments. A 32-year-old man was admitted to the emergency room after a fall on his right upper extremity. X-ray and Computed Tomography (CT) scan of the elbow revealed a minimally displaced radial head fracture (Mason type 2), with a 4 mm step (depression) at the joint surface. During the operation, at the anterior surface of the distal humerus, a full thickness chondral lesion was encountered.After removal of chondral fragments from the fractured radial head surface, it was seen that these fragments were of capitellar origin. Following radial head fixation, early active assistive motion was started. At the 6 month visit, the patient was painfree with full participation in activities of daily livingwith a DASH score of 12.5. This injury is important due to demonstration of such an extensile injury in spite of benign looking radiology. Although radial head fractures were described, these type of occult injuries may be responsible for unexplainable and unfavorable outcomes following low energy radial head fractures treated conservatively.