The purpose of this study was to evaluate the results of titanium replacement for Mason Type III comminuted fractures of the radial head. Sixteen patients were treated over a 5-year period in South Australia. Ten patients were treated acutely within 3 days of the injury and 6 patients were treated sub-acutely at an average of 37 days post injury. Mean follow-up was 2.8 years with a range of 1.2 to 4.3 years. A posterior incision was used followed by the Kocher interval which facilitated exposure of the lateral collateral ligament structures as well as the radial head. A monoblock titanium radial head from Wright Medical Technology was placed followed by repair of the lateral collateral ligament structures and possibly the medial collateral ligament structures through a separate interval.
Postoperatively patients were placed in a dynamic suspension splint for 7 days and discharged on the second postoperative day. Active and passive motion begun 2 days after the surgery. Indomethacin was used for 6 weeks to minimize the risk of heterotopic bone formation. Radiographically, there was no evidence of erosion or sclerosis of the proximal radioulnar joint or peri-prosthetic lucency with in the radial canal. The average age of the patients was 45 years with a range of 21 to 72 years. At final follow-up the mean flexion contracture was 15 degrees (range, 0-42 degrees) with a loss of 10 degrees (range, 0-25 degrees) of full flexion. There was an average loss of 12 degrees to both pronation and supination with a range of 0-45 degrees. The delay in surgery resulted in significantly diminished range of motion and lower Mayo Elbow Performance Scores. The Mayo Elbow Performance Score was 87 points with a range of 65-100 points. Eight patients had an excellent result, 5 patients a good result and 3 a fair result. The 3 fair patients were in the delayed surgical group. Seven of nine patients returned to full work activities. The average Mayo Elbow Performance score decreased from 98 points for patients with no collateral ligament injury to 88 points for those with a medial collateral ligament injury and 78 points if both collateral ligaments required surgical treatment. Final radiographs revealed a congruent joint reduction and no development of heterotopic ossification.
This paper confirms adequate results using a titanium radial head replacement for the repair of Mason Type III fractures. They had good overall results without any evidence of chondrolysis, pain, or loosening of the titanium radial head replacement at short term follow-up. The factors that significantly affected outcome included the need for ligament repair and a delay of the surgery with a 21-degree flexion contracture in the delayed surgical group versus 10 in the acutely treated group. In addition, the average flexion deformity increased from 5 degrees in patients with no ligament injury to 11 degrees in those with a medial collateral ligament repair and 26 degrees when both collateral ligaments required repair. This paper is limited by its small sample size and relatively short follow-up. Nonetheless, metallic implants are currently recommended when radial head repair is not possible in complex injuries with associated disruption of the collateral ligaments and/or interosseous membrane. The role of head replacement in “isolated” irreparable radial head fractures is not known and is currently evolving.
J of Bone and Joint Surg