Primary Nonoperative Treatment of Moderately Displaced Two-Part Fractures Of The Radial Head

Author(s): Akesson T, Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Karlsson MK

Source: J Bone and Joint Surg 88A: 1909-1914, 2006.

Summary:

This study reviewed the long-term outcome of moderately displaced two-part fractures of the radial head treated nonoperatively.  Fifteen men and 34 women with a mean age of 49 years (range, 18 - 72 years) were included in the study.  The fracture fragments were displaced 2 to 5 mm and involved greater than 30% of the joint surface.  Twenty-seven of the patients were treated with early mobilization whereas 22 individuals underwent cast immobilization for a mean of 2 weeks. 

All patients were re-evaluated with a questionnaire at a mean of 19 years (range, 14 – 24 years) after the injury and 34 patients also had a clinical and radiographic evaluation.  Six patients had a delayed radial head excision because of an unsatisfactory primary outcome.  Eighty-two percent had no elbow complaints.  Eight of the 49 patients experienced minor impaired function.  In 5 cases, this was manifested by occasional pain with loading.  Only 1 patient had severely impaired function.  Of the 6 patients with a delayed radial head excision, 4 had minor functional impairment and 2 had no complaints. 

In the 34 patients who underwent a clinical evaluation, the valgus angle was slightly greater and extension at the wrist was slightly less when the injured side was compared with the uninjured side.  The mean range of motion of the elbow (134 degrees) and forearm (173 degrees) on the injured side were not significantly different from the uninjured side.  Radiographically, degenerative changes were noted in 82% of the injured elbows compared to 20% in the noninjured elbows.  There were no cases of  nonunion, osteonecrosis, proximal radioulnar synostosis or periarticular ossification.

This study confirms relatively good results with nonoperative treatment of moderately displaced (2 – 5 mm) two fragment fractures of the radial head.  Although 82% had no elbow complaints, 6 patients did undergo a delayed radial head excision and only 4 of these had minor functional impairment.  Physical parameters of range of motion were similar to the contralateral side, but 82% showed radiographic degenerative changes compared to 21% on the contralateral elbow.  Although most patients with moderately displaced Type II radial head fractures will have relatively few complaints and good motion, most will develop radiographic degenerative changes and some may require a delayed radial head excision.  As such, this study does not change the current trend towards surgical intervention in repairable fractures of the radial head.

 

Radial, Head, Fracture, Nonoperative


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J Bone and Joint Surg