Insidious fractures of the articulating portion of the radial head: how to detect them using computed tomography

The optimal treatment for different types of partial articular radial head fractures is still a topic of debate. Loss of cortical contact between fracture fragments is considered a marker of joint instability, and fractures with this feature should be surgically treated. Among partial articular fractures, those involving the articulating portion of the radial head are underestimated. As this portion is crucial in supporting most of the axial load of the elbow, displaced partial articular fractures involving this zone can be surgically treated even if there is no complete loss of cortical contact between the fragments. In fact, fractures of the articulating portion of the radial head can be also defined as bi-articular fractures. The use of computed tomography (CT) is mandatory to detect these injuries. We describe two simple methods to identify these rare but insidious fractures with the help of two-dimensional and three-dimensional CT.