Abstract
Purpose
While performing CT examinations of the elbow, we frequently observed a previously undescribed fracture fragment of the supinator crest of the ulna. According to the anatomy of the lateral collateral ligament complex, this fracture might be an avulsion fracture of the annular ligament and/or the lateral ulnar collateral ligament. The aim of this study was to further characterize these fragments and document their associated injuries.
Methods
Retrospective evaluation of CT scans of the elbow was performed. Conventional X-ray and CT diagnoses were used to systematically document any associated injuries.
Results
A total of 152 CT scans were evaluated. The fragment in question was discovered in 17 patients (11.2 %). The average age of the patients was 40 years (±14.9; 9–71 years). The fragment size varied between a few millimetres and 2.4 cm. Multifragmented fractures were observed. In 82.3 % of the cases, associated radial head fractures were diagnosed. In 29.4 %, a coronoid process fracture was present. Distal humerus fractures were found in 23.5 %. Instability in the medial collateral ligament and an Osborne-Cotterill lesion were found in 11.8 % of the patients, respectively.
Conclusions
In a significant percentage of the population, a previously undescribed fracture fragment of the supinator crest of the ulna could be detected. The most frequently occurring associated injuries were fractures of the radial head, the coronoid process, and the distal humerus. The aetiology of these lesions is unknown; however, bony avulsion of the annular or the lateral ulnar collateral ligament seems to be the most likely cause. If this fragment is to be diagnosed by CT, the possibility of lateral or posterolateral instability should be considered.
Similar content being viewed by others
References
Kobayashi Y, Oka Y, Ikeda M, Munesada S (2000) Avulsion fracture of the medial and lateral epicondyles of the humerus. J Shoulder Elbow Surg 9(1):59–64
Osborne G, Cotterill P (1966) Recurrent dislocation of the elbow. J Bone Joint Surg Br 48(2):340–346
Glajchen N, Schwartz ML, Andrews JR, Gladstone J (1998) Avulsion fracture of the sublime tubercle of the ulna: a newly recognized injury in the throwing athlete. AJR Am J Roentgenol 170(3):627–628
Johnston GW (1962) A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 31:51–61
Schatzker J (1987) Olecranon fractures. In: Schatzker J, Tile M (eds) The rational of operative fracture care. Springer, Berlin, pp 80–87
O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD (2003) Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 52:113–134
Müller M, Nazarian S, Koch P (1987) The AO classification of long bones. Springer, Berlin
Bado JL (1967) The Monteggia lesion. Clin Orthop Relat Res 50:71–86
O’Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73(3):440–446
Charalambous CP, Stanley JK (2008) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Br 90(3):272–279. doi:10.1302/0301-620X.90B3.19868
Jensen SL, Olsen BS, Tyrdal S, Sojbjerg JO, Sneppen O (2005) Elbow joint laxity after experimental radial head excision and lateral collateral ligament rupture: efficacy of prosthetic replacement and ligament repair. J Shoulder Elbow Surg 14(1):78–84. doi:10.1016/j.jse.2004.05.009
Cohen MS, Hastings H 2nd (1997) Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Joint Surg Am 79(2):225–233
Seki A, Olsen BS, Jensen SL, Eygendaal D, Sojbjerg JO (2002) Functional anatomy of the lateral collateral ligament complex of the elbow: configuration of Y and its role. J Shoulder Elbow Surg 11(1):53–59. doi:10.1067/mse.2002.119389
Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 83-A(12):1823–1828
Olsen BS, Vaesel MT, Sojbjerg JO, Helmig P, Sneppen O (1996) Lateral collateral ligament of the elbow joint: anatomy and kinematics. J Shoulder Elbow Surg 5(2 Pt 1):103–112
Morrey BF, An KN (1985) Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res 201:84–90
O’Driscoll SW, Horii E, Morrey BF, Carmichael SW (1992) Anatomy of the ulnar part of the lateral colateral ligament of the elbow. Clin Anat 5(4):296–303
van Riet RP, Morrey BF (2008) Documentation of associated injuries occurring with radial head fracture. Clin Orthop Relat Res 466(1):130–134. doi:10.1007/s11999-007-0064-8
Van Riet RP, Van Glabbeek F, Morrey BF (2009) Radial head fracture. In: Morrey BF, Sanchez-Sotelo J (eds) The elbow and its disorders, 4th edn. Saunders Elsevier, Philadelphia, pp 359–381
Itamura J, Roidis N, Mirzayan R, Vaishnav S, Learch T, Shean C (2005) Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg 14(4):421–424. doi:10.1016/j.jse.2004.11.003
Johannsson O (1962) Capsular and ligamentous injuries of the elbow joint. Acta Chir Scand Suppl:287
McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW (2003) The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 12(4):391–396. doi:10.1016/mse.2003.S1058274603000272
Odelberg-Johnson G (1924) On fractures of the proximal portion of the radius and their causes. Acta Radiol 3:45–53
Galik K, Baratz ME, Butler AL, Dougherty J, Cohen MS, Miller MC (2007) The effect of the annular ligament on kinematics of the radial head. J Hand Surg Am 32(8):1218–1224. doi:10.1016/j.jhsa.2007.06.008
Olsen BS, Sojbjerg JO, Dalstra M, Sneppen O (1996) Kinematics of the lateral ligamentous constraints of the elbow joint. J Shoulder Elbow Surg 5(5):333–341
Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ (2005) The effect of radial head fracture size on elbow kinematics and stability. J Orthop Res 23(1):210–217. doi:10.1016/j.orthres.2004.06.001
Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ (2004) The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 86-A(8):1730–1739
Ebrahimzadeh MH, Amadzadeh-Chabock H, Ring D (2010) Traumatic elbow instability. J Hand Surg Am 35(7):1220–1225. doi:10.1016/j.jhsa.2010.05.002
Olsen BS, Sojbjerg JO, Nielsen KK, Vaesel MT, Dalstra M, Sneppen O (1998) Posterolateral elbow joint instability: the basic kinematics. J Shoulder Elbow Surg 7(1):19–29
O’Driscoll SW, Morrey BF, Korinek S, An KN (1992) Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 280:186–197
Stuffmann E, Gannon A, Clemente J, Baratz ME (2009) Radial head prosthesis update. Tech Should Elbow Surg 10(1):31–38
Chanlalit C, Shukla DR, Fitzsimmons JS, Thoreson AR, An KN, O’Driscoll SW (2011) Radiocapitellar stability: the effect of soft tissue integrity on bipolar versus monopolar radial head prostheses. J Shoulder Elbow Surg 20(2):219–225. doi:10.1016/j.jse.2010.10.033
Leppilahti J, Jalovaara P (2000) Early excision of the radial head for fracture. Int Orthop 24(3):160–162
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schmidt-Horlohé, K., Wilde, P., Kim, YJ. et al. Avulsion fracture of the supinator crest of the proximal ulna in the context of elbow joint injuries. International Orthopaedics (SICOT) 37, 1957–1963 (2013). https://doi.org/10.1007/s00264-013-1976-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-013-1976-4