This study reviews 5 patients with an isolated nonunion of the radial head or neck. Three patients had a Mason Type III fracture and two patients had a radial neck fracture. One fracture was non-displaced and four had limited displacement. There were 3 men and 2 women with an average age of 50 years (range, 43-47). Four patients were treated non-operatively, remained asymptomatic and regained normal strength and full range of motion. Three patients were only followed radiographically until 6,10, and 10 months, respectively. They maintained asymptomatic non-unions. The fourth patient had a radiographic nonunion at 13 months post injury, but exhibited radiographic evidence of healing at 20 months. One patient was successfully treated with ORIF and iliac crest bone graft due to symptomatic clicking.
All patients in this study were treated with limited immobilization (1-2) weeks followed by early range of motion. The denominator of the 5 patients or incidence of nonunion accumulated over 6 years is not apparent from this study, but confirms that even if a nonunion occurs as an isolated injury, it will often be asymptomatic not requiring aggressive treatment. This study reinforces the current treatment algorithm used for radial head and neck fractures that emphasizes early motion to minimize stiffness, which is less well tolerated. It also suggests that following a patient until radiographic healing may not be necessary when symptoms are minimal. However, it does not help the clinician decide when to begin strengthening and full use of the extremity and whether early strengthening may lead to a higher incidence of nonunion.