Arthroscopic treatment of fractures of the radial head

An original technique for the arthroscopic diagnosis and treatment of the fractures of the radial head is proposed and described. The elbow arthroscopy is started with a 4.5-mm 30 degrees arthroscope from the proximal anteromedial portal and the anterior elbow is examined; then a proximal anterolateral portal is created and a full-radius blade inserted to take out the hematoma and to allow visualization of the radial head that is explored through the whole range of motion to visualize the fracture fragment. The fragment is manipulated by means of arthroscopic tools to reduce the anteromedial surface of the radial head. The arthroscope is now switched to the posterolateral portal and the posterior aspect of the humeral radial joint is visualized. The soft spot portal is used to insert a periosteal elevator to complete the reduction and firmly hold the fragment in the reduced position. An anterolateral portal is now created to allow the safe insertion of a guidewire, angled 45 degrees to the longitudinal axis of the radius, to pierce the fragment with. A 14-mm long cannulated screw is inserted along the guide after specific drilling. Finally, the reduction and the stability of the fixation are checked with during full rotation of the elbow. The described procedure has been performed in 6 patients. Short-term preliminary results show a satisfactory functional outcome. Among the advantages of the technique are the minimally invasive approach, the direct visualization of the fracture, and the benefits derived from the radiation-free procedure.