Radial Head Fractures: Outcomes Of Different Surgical Treatments

Background Fractures of radial head account for 2,5 of all fractures and 1/3 of fractures involving the elbow. This kind of lesion is often underappreciated; multifragmentary patterns, concomitant elbow dislocation or associated fractures can lead to poor outcomes. Objectives The aim of this study was to evaluate outcomes of patients treated surgically with three different techniques (resection of radial head, radial head arthroplasty and osteosynthesis), outline possible predictive factors of worse results and identify the best surgical option for Mason type III and Mason type IV fractures. Study Design & Methods Data were retrospectively collected for 59 patients treated surgically in our department between January 2006 and December 2017. At follow-up a clinical evaluation with the Mayo elbow performance score (MEPS) and a radiographic assessment were performed. Results were statistically analyzed using SPSS IBM software. Mann-Whitney tests were performed in order to investigate if any single surgical procedure was preferable over another according to the pattern of fracture; multiple linear regression analyses were performed to identify predictive factor of worse MEPS, worse range of motion, instability and increased pain. Results The average age was 50; the mean follow-up was 48 months. 7 patients (12%) had Mason type II fractures, 23 type III (39%), 29 type IV (49%). Mason II fractures were all treated with osteosynthesis; Mason III in 6 cases with osteosynthesis, 15 with radial head resection and 2 with prosthesis. Mason IV patterns were treated in 7 cases with osteosynthesis, in 12 with radial head resection and in 10 with replacement of the radial head. Statistical analysis did not show significant difference for MEPS at follow-up between fractured and contralateral elbow. Age, gender, side, associated lesions, grade of osteoarthritis, type of treatment, duration of postoperative rehabilitation were not predictive factors of poor MEPS; conversely, coronoid fractures were associated to a lower stability of the elbow. Mason type IV fractures treated with radial head arthroplasty were associated with higher outcomes (p=0,012). Conclusions In Mason type II patterns the osteosynthesis is advisable and simple to execute.Regarding Mason type IV, the terrible triad represent the harder challenge for the surgeon; when primary stabilizer of the elbow are injured, the perfect congruency of radiohumeral joint is mandatory to restore the stability and radial head arthroplasty is the best choice. For Mason III fractures it was not possible in our data analysis to identify the best choice of treatment, proving the difficulty, as shown in the literature, to have an univocal and safe management; the discriminating factor on the treatment is, in our opinion, the maintenance of elbow stability that must be always assessed intraoperatively.