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Outcomes of Concomitant Fractures Of The Radial Head And Capitellum: The Kissing Lesion
Femke MAP Claessen, MD; Amir R. Kachooei, MD; Kirsten K.J. Verheij, MD; Gregory P. Kolovich, MD; Chaitanya S. Mudgal, MD
Massachusetts General Hospital, Boston, MA

Background: Radial head compression against the capitellum in this position may cause concomitant fracture of the capitellum.

Hypothesis: We hypothesized that radial head fracture type was not predictive of the presence of a kissing lesion, and capitellar fracture type was also not predictive of the presence of a kissing lesion.
Methods: Data were identified from 5 area hospitals. The first 2 hospitals are level 1 trauma centers, the third is a community hospital tied to a level 1 trauma center, and the latter 2 hospitals are community hospitals. We retrieved records of patients over 18 years of age who underwent treatment for capitellum fracture and radial head fracture between January 1993 and 2014. Patients with olecranon fractures or trochlea fractures were excluded. Patients without surgical notes were also excluded.
Results: A total of 10 patients with a radial head fracture and a concomitant capitellum fracture were included. Based on the operative reports, 9 radial head fractures were classified as Hotchkiss Modification of the Mason Classification type II, and 1 was classified as type I. Based on the available radiographs and computed tomography, 3 capitellum fractures were type I, and 7 were type II according to the Grantham classification.
Conclusions: Surgeons have to be alert to capitellar damage in case of a Hotchkiss type II radial head fracture. An additional computerized tomography of the elbow should be performed, and during operative treatment of the radial head, a careful inspection of the capitellum is recommended to avoid a missed diagnosis and subsequent complications.

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