Violence and gunshot wounds are a very concerning social phenomenon of our era. A teenager presented with a gunshot wound to the elbow. The entry side was to the lateral aspect of the elbow and no exit wound was found. There was no vascular or nerve damage as the bullet went into the radial head through the Kocher interval. On exam there was limited motion in forearm rotation. Initially, the family was consulted against removal of the bullet. The family insisted to have the bullet removed after explaining risks and benefits of the procedure. The main concerns were (1) AVN due to the trauma (2) Removal of the bullet could lead to collapse of the radial head and eventually radial head excision.
Alternatively, radial head replacement could have been performed, however the risks of capitellar arthritis in the midterm are significant after such procedure.
Treatment consisted of removal of the bullet which demonstated that the radial head was stable.
Unfortunately, over the course of months the patient developed
(1) AVN, collapse of the head,
(2) limited forearm rotation
The patient was eventually treated with radial head excision.
His course was complicated by a synovial fistula that was repaired.
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| XR at the time of injury |
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| XR at the time of injury |
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| Postoperative XR after removal of bullet |
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| Postoperative XR after removal of bullet |
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| 4 months after removal of bullet there is collapse of the radial head with loss of normal contour |
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| 4 months after removal of bullet there is collapse of the radial head with loss of normal contour |
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| 4 months after removal of bullet there is collapse of the radial head with loss of normal contour |
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| Radial head excision |
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| Radial head excision |
