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Combined fractures in the capitellum and the radial head associated with medial capsular avulsion.

We present a case with an unusual fracture. A 28-year-old man presented a painful and swollen left elbow after falling down. Radiographs revealed combined fractures in the capitellum and the radial head associated with a medial capsular avulsion. Two osteochondral fragments from the capitellum were found at the operation. One was the free fragment revealed on radiographic examination. Another was not revealed before the operation and was found piercing the fracture line of the radial head. These two fragments were removed. The radial head fracture was reduced and was fixed using two Herbert screws. It is very difficult to detect a fragment of the capitellum that impaled the radial head on a plain radiogram before operation. Also, a capsular injury and/or ligamentous injury is often overlooked. This fact should be kept in mind whenever a non-operatively treated radial head fracture fails to respond as expected.