An isolated posterior dislocation of radial head in adults is a rare injury. We report a 32-year-old male patient with posterior dislocation of radial head associated with articular fracture fragment of the radial head. Open reduction and internal fixation with a miniscrew was done and patient had excellent outcome at a follow up of 2 years.

1. An isolated posterior dislocation of radial head in
adults - A rare injury: A case report

2. Case Report
An isolated posterior dislocation of radial head in
adults e A rare injury: A case report
A.P. Singh a,f
, V. Garg b,*,f
, R. Vaishya c,f
, A.P. Singh d,f
, R. Raman e,f
a
Consultant Orthopaedic Surgeon, Punjab Civil Medical Services-1, Mukerian,
Punjab 144211, India
b
Fellow Arthroscopy, ISKSAA, Dept of Orthopedics, Delhi 110034, India
c
Professor Orthopedics, Indraprastha Apollo Hospitals, New Delhi 110076, India
d
Consultant Orthopedics, Kanwar Hospital and Research Centre, Hajipur, Hoshiarpur,
Punjab 144211, India
e
Consultant Orthopedic, Vardhman Govt. Medical College, West Bengal 713144, India
a r t i c l e i n f o
Article history:
Received 2 April 2014
Accepted 7 May 2014
Available online xxx
Keywords:
Radial head fracture
Post dislocation elbow
Monteggia fracture
Radial head fixation
a b s t r a c t
An isolated posterior dislocation of radial head in adults is a rare injury. We report a 32-
year-old male patient with posterior dislocation of radial head associated with articular
fracture fragment of the radial head. Open reduction and internal fixation with a minis-
crew was done and patient had excellent outcome at a follow up of 2 years.
Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Isolated posterior dislocation of radial head is a rare injury
especially in skeletally mature individuals.1
Usually posterior
dislocation of radial head is common in children and is
considered under the monteggia variant. Earlier reports of
cases of acute radial head dislocation in adults have been
associated with either ulna fracture or elbow dislocations.2
2. Case report
A 32-year-old male presented with painful left elbow held in
slightly flexed and supinated position in the emergency room.
He had a history of fall on his non-dominant left hand.
Swelling was obvious on lateral and posterior aspect of elbow.
On examination all rotatory movements were restricted and
painful. There was no tenderness on medial side of elbow,
* Corresponding author.
E-mail address: vip.ucms@gmail.com (V. Garg).
f
Source e Kanwar Hospital and Research Centre, Hajipur, Hoshiarpur, Punjab, India.
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
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Please cite this article in press as: Singh AP, et al., An isolated posterior dislocation of radial head in adults e A rare injury: A case
report, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.05.011
http://dx.doi.org/10.1016/j.apme.2014.05.011
0976-0016/Copyright © 2014, Indraprastha Medical Corporation Ltd. All rights reserved.

3. forearm or distal radioulnar joint. Neurovascular examination
was within normal limits.
Radiographs of elbow showed posterior radial head dislo-
cation with intra-articular fracture fragment of radial head
displaced superiorly (Figs. 1 and 2). There was no other asso-
ciated bony injury.
3. Surgical technique
Patient was taken for open reduction and exploration of the
joint. Kocher approach with proximal extension was used
with careful dissection to preserve the soft tissue attachment
of the fractured fragment. Annular ligament was torn. Radial
head was lifted anteriorly by pressure of small Hohmann re-
tractors placed subperiosteally. Radial head articulation with
capitellum was confirmed. A 1.5 mm Kirschner wire (K-wire)
was used to temporarily fix the articular fragment. A 2.7 mm
miniscrew (Max ortho, Bombay, India) was used to fix the
fractured fragment and articular congruity and stability was
confirmed. Thorough joint lavage was done. Annular ligament
was reconstructed. A 2 mm K-wire was used to fix the radio-
capitellar joint in neutral position of forearm. The K-wire was
removed at 2 weeks and flexion extension movements of the
elbow were initiated. Rotatory movements were started at 3
weeks. At 8 weeks light weight lifting was allowed. After a
follow up of 2 years the patient had 0e110
of movement with
full pronation and supination (Figs. 3 and 4).
4. Discussion
Isolated dislocation of the radial head without concomitant
ulnar fracture or humeroulnar subluxation in adults is a rare
injury.1,3e7
Most of the earlier reported cases were in children
and were considered monteggia variants.2
Fig. 1 e AP radiograph pre-operative.
Fig. 2 e Lateral radiograph pre-operative.
Fig. 3 e AP radiograph post-op.
Fig. 4 e Lateral radiograph post-op.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e32
Please cite this article in press as: Singh AP, et al., An isolated posterior dislocation of radial head in adults e A rare injury: A case
report, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.05.011

4. Heidt and Sterne, in 1982, were the first to describe this
injury.1
Only 20 cases have been reported in adults in the
literature,6
but we were not able to find any case in literature
where posterior dislocation is associated with intra-articular
fracture of radial head.
The mechanism leading to an isolated radial dislocation
has been variously described. Most authors describe an indi-
rect mechanism. The proximal radioulnar joint is most stable
in supination: in this position, the contact between radius and
ulna is maximal and the interosseous membrane, the annular
ligament, and the anterior fibres of the quadrate ligament are
all taut, thus drawing the radial head snugly against its notch
in the ulna. Cadaveric studies have shown that posterior
dislocation of the radial head cannot occur without the
rupture of the annular ligament; in addition, partial tear of the
quadrate ligament and the proximal interosseous membrane
takes place. We speculate the mechanism in our patient to be
a hyperextension of the elbow with forearm in prone position
leading to a posterior dislocation of the radial head.
There are no guidelines for treatment. Most of these cases
with isolated posterior radial head dislocation were treated
conservatively except two cases.6,7
In one case open reduction
was performed due to soft tissue interposition6
and in second
one open reduction was done because of persistent instability
of radial head and annular ligament reconstruction was
done.7
In our case we reconstructed radial head and annular
ligament and radio capitullar K-wire was applied for 2 weeks.
Most of these reported cases showed excellent result
following prompt diagnosis and reduction. Hence it is very
necessary to identify these injuries as soon as possible and
treat them promptly especially when associated with intra-
articular fractures.
The recognition of such injuries is of paramount impor-
tance to prevent early degenerative arthritis of elbow. In our
case we found that open reduction and internal fixation of
posterior radial head dislocation with articular fracture yields
excellent results.
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Heidt Jr RS, Stern PJ. Isolated posterior dislocation of the
radial head. A case report. Clin Orthop Relat Res. 1982;168:
136e138.
2. Bado JL. The monteggia lesion. Clin Orthop. 1967;50:71e78.
3. Negi AK, Pestonji MD, Iyer S. Isolated posterior dislocation of
the radial head in an adult. J Postgrad Med. 1992;38:143.
4. Ibrahimi AE, Shimi M. Isolated, traumatic posterior dislocation
of the radial head in an adult: a new case treated
conservatively. J Emerg Trauma Shock. 2010
OcteDec;3(4):422e424.
5. Bonatus T, Chapman MW, Felix N. Traumatic anterior
dislocation of the radial head in an adult. J Orthop Trauma.
1995;9:441e444.
6. Takami H, Takahashi S, Ando M. Irreducible isolated
dislocation of the radial head. Clin Orthop Relat Res.
1997;345:168e170.
7. Dhawan A, Hospodar PP. Isolated posttraumatic posterior
dislocation of the radial head in an adult. Am J Orthop.
2002;31:83e86.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e3 3
Please cite this article in press as: Singh AP, et al., An isolated posterior dislocation of radial head in adults e A rare injury: A case
report, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.05.011

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