Lim Lee Kai, Beh Joey
Department of Radiology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore.
BJR Case Rep. 2020 Nov 17;7(2):20200111. doi: 10.1259/bjrcr.20200111. eCollection 2021 Apr 1.
We describe a case of an anteromedial fracture-dislocation of the radial head in an adult patient, which was initially irreducible using closed means, and remained challenging to reduce despite open surgery. Further advanced CT/MRI revealed entrapment of the radial head due to the interposition of the brachialis tendon posteriorly, thereby preventing sustained reduction. While three other cases of irreducible anteromedial radial head dislocation due to the brachialis tendon have been reported in the English surgical literature, none of the imaging findings have been described in the radiological literature. Only one other case published in a surgical journal briefly demonstrated pre-operative MRI imaging. We would like to share the value of pre-operative MRI in this rare presentation, which would be helpful in diagnosing not only cases with interposition of the brachialis tendon, but potentially other types of soft tissue interposition which also limit closed reduction. To the best of the authors' knowledge, this would be the first report on the imaging findings in a radiological journal. Awareness of this phenomenon would assist radiologists in the diagnosis and management of this rare condition.
我们描述了一例成年患者桡骨头前内侧骨折脱位的病例，该病例最初采用闭合方法无法复位，即便进行了开放手术，复位仍具有挑战性。进一步的高级CT/MRI显示，肱肌肌腱在后方嵌入导致桡骨头被困，从而妨碍了持续复位。虽然英文外科文献中已报道了另外3例因肱肌肌腱导致的不可复位性桡骨头前内侧脱位病例，但放射学文献中均未描述其影像学表现。仅一篇发表在外科杂志上的其他病例简要展示了术前MRI成像。我们希望分享术前MRI在这种罕见病例中的价值，这不仅有助于诊断肱肌肌腱嵌入的病例，还可能有助于诊断其他类型的限制闭合复位的软组织嵌入病例。据作者所知，这将是放射学杂志上关于影像学表现的首篇报道。认识到这种现象将有助于放射科医生对这种罕见病症进行诊断和管理。
