Anterior Migration of a Radial Head Fracture Fragment Endangering the Brachial Artery During Surgery: A Case Report and Literature Review

Vascular injury around the elbow is rare but potentially limb-threatening. While most reported cases involve elbow dislocations or pediatric supracondylar fractures, migration of a comminuted radial head fragment toward the cubital fossa is exceedingly uncommon and can result from manipulation. A 25-year-old male sustained a severely comminuted (Mason type III) radial head fracture following a fall on an outstretched arm. Surgery was undertaken under brachial-plexus block anesthesia through a lateral (Kocher) approach. Because of the degree of comminution, a radial head replacement with hydroxyapatite-coated size-23 prosthesis was carried out. Intraoperatively, one osteochondral fragment (≈1 cm × 1 cm) migrated anteriorly into the cubital fossa, abutting the brachial artery due to manipulation to retrieve. A vascular surgeon performed safe retrieval through an anterior exposure to prevent arterial kinking of brachial artery. Intraoperative and postoperative vascular status was confirmed by direct digital palpation, portable Doppler, and dynamic flexion-extension testing. Postoperative recovery was uneventful without neurovascular compromise. At a 12-week follow-up, the patient demonstrated 10°–130° flexion/extension arc, near–full pronation and supination, and a normal Quick DASH score. Comminuted radial-head fractures may generate loose fragments which can end up in the antecubital fossa due to manuvering and threaten vital neurovascular structures. This case emphasizes the importance of multidisciplinary collaboration (orthopedic + vascular), higher vigilance for fragment migration, intraoperative imaging and dynamic assessment, and early vascular-surgery backup in complex elbow fractures.