Chondral lesion of capitellum humeri accompanying radial head fracture: a case report

In this case report we present a case of full thickness chondral lesion of anterior-distal surface of capitellum humeri, accompanying an intra-articular radial head fracture. Importance of this case is the resemblance of chondral injury to Lorenz-Kocher lesion of humerus and atypical displacement of chondral fragments. A 32-year-old male, admitted to emergency room after fall on his right upper extremity. X-ray and CT scan of elbow revealed a minimally displaced radial head fracture (Mason type 2), with a 4 mm step (depression) at joint surface. During the operation, at the anterior surface of the distal humerus, a full thickness chondral lesion was encountered. After removal of chondral fragments from the fractured radial head surface, it was seen that these fragments were of capitellar origin. Following radial head fixation, early active assistive motion was started. At the 6 month visit, the patient was pain-free with full participation in activities of daily living with a DASH score of 12,5. This injury is important due to demonstration of such an extensile injury in spite of benign looking radiology. Although radial head fractures were described, these type of occult injuries may be responsible from unexplainable and unfavorable outcome following low energy radial head fractures, treated conservatively.