This study is a retrospective review of 100 patients treated with uncomplicated Mason II and III fractures of the radial head and neck at a mean of 19 years. Seventy women and 30 men were at a mean of 47 years old when they sustained the fracture in Malmo, Sweden. Forty-four patients were treated with sling immobilization, 34 with cast immobilization, 19 with resection of the radial head, and 2 with radial head open reduction. Secondary excision was performed because of residual pain in 9 patients after a mean of 13 months. Seventy-seven patients had no symptoms, 21 had occasional pain and 2 had daily pain. The injured elbows had less flexion (138 degrees +/- 8 degrees compared with 140 degrees +/- 7 degrees) and less extension (-4 degrees +/- 8 degrees compared with –1 degree +/- 6 degrees) then did the uninjured elbows, and there was less supination of the forearm on the injured side (83 degrees +/- 11 degrees compared with 86 degrees +/- 6 degrees). Seventy-six percent of radiographs revealed degenerative changes, compared with 16% on the uninjured side. The annual incidence of fractures of the radial head or neck was 2.9 per 10,000 individuals (16 years of age or older).
This study made use of a small Swedish city trauma registry to identify an annual incidence of fracture of the radial head and neck. As noted in previous studies, long-term outcome of such fractures is generally favorable with no significant symptomatic arthrosis despite a high prevalence of radiographic degenerative changes. This article also indicates a low prevalence of joint stiffness. There was a trend towards patients with secondary radial head excision to have an inferior outcome compared to those with primary excision. However, considering treatment was not randomized and this was a retrospective study, this is not clear. In addition, the study’s definition of “uncomplicated” is not entirely clear. Notwithstanding, the results following uncomplicated Mason II and III fractures are predominantly favorable even after a mean of 19 years following the initial injury.
Journal of Bone and Joint Surgery