Abstract
Background
Fractures of the radial head result from an axial force that causes impaction against the capitellum. Associated lesions of the capitellum in this pattern of injury have been previously reported in the orthopaedic literature as an uncommon occurrence.
Methods
All patients presenting to the clinics of the senior surgeon between 1998-2008 with radial head fractures requiring surgery were included. Data collected included demographics (age, gender, side of injury), mechanism, timing of injury and injury type (Mason classification). Intraoperative findings including evidence of union, capitellar injury, associated joint dislocation, collateral ligament injury, and any other fractures around the elbow were documented.
Results
We reviewed 109 consecutive patients presenting with radial head fractures. 67% of the patients were found to have the PLUCCAR lesion, a capitellar slither of cartilage impacted in the radial fracture. Of these, 76.9% of patients with a Mason I injury had a PLUCCAR lesion, 76.7% of patients with Mason II injury had a PLUCCAR lesion, and only 33.3% of patients with Mason III lesion had a PLUCCAR lesion. 13 patients had a pre-existing non-union, 84% of whom had a PLUCCAR lesion. 19 patients were found to have a malunion, 84% of whom were found to have the PLUCCAR lesion.
Conclusion
Injury to the capitellum is commonly associated with radial head fracture. We term impaction of a capitellar fragment in the radius a PLUCCAR lesion. There is an increased incidence of this injury in less comminuted radial head fractures, and in patients presenting with non union or malunion of a radial head fracture.
