Use of surgical glue for Mason type III radial head fracture
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A 48-year-old man was admitted to our hospital, with a complaint of right elbow pain, after falling down with the wrist and hand in extension. Physical examination revealed palpable swelling and pain around the radial head. There was no tenderness in the olecranon and the medial aspect of the elbow. Motion of the right elbow was limited due to the pain. The patient denied pain of the wrist or paresthesia of the right hand. The elbow radiography and computed tomography (CT) demonstrated a Mason type III radial head fracture.

The patient underwent ORIF 2 days after injury, and general anesthesia was applied. The patient lay in a supine position, with tourniquet on the upper arm. The arm was placed over the chest on a bolster to support the extremity. The Kocher approach was adopted to expose the radial head. The annular ligament and capsule were longitudinally dissected. Intraarticular hematomas were irrigated. The fracture fragments of the radial head were explored and retrieved. Radial head reconstruction was performed precisely on the operation table. The comminuted fragments were bonded with surgical glue (n-butyl-2-cyanoacrylate; Compont Medical Devices Co., Ltd., Beijing, China) to restore the configuration of the radial head. The surgical glue is a colorless transparent liquid stored in a vial. A straw was used to remove the glue from the vial and apply it to the fracture fragments to bond them together.

The radial head was fixed temporarily with 1-mm Kirschner wires, which were also guide wires. Two interfragmentary screws, which were headless Bold cannulated compression screws (General Care Int’l, Shanghai, China), were used followed by removal of the Kirschner wires. The reduced radial head was then reimplanted in situ. Definitive fixation was achieved using a low-profile mini-plate (DePuy Synthes, Suzhou, China), which was placed on the safe zone so as to not interfere with the rotational movements of the forearm. Intraoperative fluoroscopy was used to confirm that the fracture was well reduced and secured. The wound was irrigated, and the capsule and annular ligament were repaired with absorbable sutures. Stability and range of motion of the elbow were carefully checked. At the end of the procedure, the distal radioulnar joint was examined clinically as well as under fluoroscopy to exclude an Essex–Lopresti lesion.

Above-elbow plaster was applied for a week followed by a removable splint for 3 weeks. Free active motion and forearm rotation were initiated. A postoperative CT was used to evaluate the reduction quality after the surgery. The fracture received anatomic reduction. Anteroposterior and lateral views of the elbow radiography were taken at the follow-up. Bone union was achieved at 12 weeks. In the 4th month, the patient was participating in usual work and completely pain free. The latest follow-up was 2 years after the operation. The patient was satisfactory with the result.

Source: Medicine: May 2019 - Volume 98 - Issue 22 - p e15863

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