Open Reduction Internal Fixation of Fractures of the Radial Head

Author(s): Ring D, Quintero J, Jupiter JB

Source: J Bone and Joint Surg 84-A: 1811-1815, 2002

Summary:

This study reviews the results of ORIF of intra-articular radial head fractures in 56 patients.  30 patients had a Mason type II (partial articular) fracture, and 26 had a Mason type III (complete articular) fracture.  48% were part of a more complex injury pattern involving either a fracture-dislocation or an injury to the medial collateral ligament.  Prior indication for operative intervention was restriction of forearm rotation by displaced fracture fragments or to maintain length and stability when associated with complex injury patterns.  The operative procedure was performed by 21 different surgeons, often via a Kocher interval.  One third of Mason type II fractures were treated with a 2.0mm T-shaped plate and screws where as the remaining 26 were treated with screws alone.  Of the 26 Mason type III fractures, 22 were treated with a plate and screws and the remaining 4 fractures were treated with screws alone.  Of the Mason type II fractures, the average arc of elbow motion was 119 degrees with an average arc of forearm rotation of 144 degrees.  14 patients had no pain; 14 had mild pain; and 1 had moderate pain.  There was 1 non-union; 1 radioulnar synostosis; and mild elbow instability.  Four patients had limitation of forearm rotation less than 100 degrees and all 4 were associated with a comminuted fracture and a more complex injury pattern.  In Mason type III fractures, a second operation was required to resect the radial head in 10 of the 26 patients due to early fixation failure or non-union.  Of the remaining 16 patients with the retained head in Mason type III fractures, the average arc of elbow motion was 111 degrees and 127 degrees of forearm rotation.  Of the 14 patients with the Mason type III fracture and more than 3 articular fragments, 3 had failure of fixation requiring radial head excision, 6 had a painful non-union treated with excision and 4 recovered less than 100 degrees of forearm rotation leaving only one satisfactory result.

 

Although it is well established that repairing or replacing the radial head may be quite important for maintaining elbow stability, especially when associated with medial collateral ligament injury or interosseous membrane disruption, the decision between repair and replacement is not always clear.  This paper provides some information suggesting that isolated Mason type II and Mason type III fractures with less than 3 articular fragments have a higher probability of a satisfactory result, where as Mason type II and III fractures associated with complex forearm and elbow injuries or significant comminution with greater than 3 articular fragments have a higher chance an unsatisfactory result.  This is commonly due to either hardware failure, development of non-union, or loss of motion.  Although there are notable limitations of this article, as evidence by 21 different surgeons without a standard, the results appear consistent.

 


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