J Korean Fract Soc.  2019 Oct;32(4):173-180. 10.12671/jkfs.2019.32.4.173.

Open Reduction and Internal Fixation in Comminuted Radial Head Fracture

• Lee JK
• Kim TH
• Kim C
• Han SH

• KMID: 2468679
• DOI: http://doi.org/10.12671/jkfs.2019.32.4.173

Abstract

PURPOSE
Radial head fractures, which account for 33% of all fractures, are treated depending on the Mason classification. In comminuted type 3 fractures, open reduction internal fixation (ORIF), and radial head arthroplasty are the treatment options. This study examined the clinical outcome of modified Mason type 3 radial head fractures using ORIF with a plate.
MATERIALS AND METHODS
The medical records and image of 33 patients, who underwent ORIF for modified Mason type 3 radial head fractures, were reviewed retrospectively. The preoperative plain radiographs and computed tomography images were used to examine the location of the fracture of the radial head, the number of fragments, union, joint alignment, and traumatic arthritis at the final follow-up. The range of motion (ROM) of the elbow at the last follow-up, pain score (visual analogue scale), modified Mayo elbow score (MMES), and complications were analyzed for the clinical outcome.
RESULTS
Of the 33 cases, 14 were men and 19 were women. The mean age was 41.8 years and the average follow-up period was 19 months. The functional ROM was divided into three groups according to the number of bone fragments: 141.2°±9.3° of 3 (n=20), 123.8°±18.5° of 4 (n=7), 100.7°±24.4° of more than 4 (n=6). Furthermore, the MMES were 88.2±2.9, 83.7±4.3, and 77.3±8.4, respectively (p=0.027). Depending on the radial head fracture location, the ROM and MMES were 130.7°±7.5° and 82.1±4.7, respectively, with poor outcomes on the ulnar aspect compared to 143.1°±3.8° and 89.9±3.2 on the radial aspect.
CONCLUSION
Various factors, such as the degree of crushing and location involved in the clinical outcome. In particular, the result was poor in the case of more than four comminuted fragments or chief position located in the ulnar aspect. In this case, radial head arthroplasty may be considered in the early stages.

Keyword

Radial head fractures; Fracture fragment; Fracture location; Internal fixation

MeSH Terms

Arthritis
Arthroplasty
Classification
Elbow
Female
Follow-Up Studies
Fractures, Open
Head*
Humans
Joints
Male
Medical Records
Range of Motion, Articular
Retrospective Studies

Figure

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  Fig. 1. Radiologic assessment of the fracture pattern. R: radial side, U: ulnar side.

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  Fig. 2. A 57-year-old man sustained a comminuted radial head fracture of the right elbow after a fall from a 1 m height. (A-C) The plain X-ray and three-dimensional computed tomographic scans detected anterior aspect radial head fracture with three fragmentation. (D, E) Open reduction and plate fixation were carried out and solid union was achieved.

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  Fig. 3. Despite the small heterotrophic ossification at postoperative one year, the functional result was favorable with a range of motion (extension-flexion: 0°-130°, pronation-supination: 80°-80°) and 95 of the modified Mayo elbow score.

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  Fig. 4. (A, B) A 55-year-old woman fell on the ground with an outstretched hand and was diagnosed with a radial head fracture on the left elbow at the initial X-ray. (C, D) The three-dimensional computed tomographic scans revealed multi-fragmentary, five fragments, a radial head fracture with displacement in the overall radial head.

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  Fig. 5. Open reduction and internal fixation were conducted (A, B), but a postoperative 1 year, the patient presented with partial fragment nonunion (C, D). The range of motion was 10° to 120° flexion and the modified Mayo elbow score was 80.

Reference

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