Radial Head Fractures

Background:Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries.Methods:A literature search was performed and the authors’ personal experiences are reported.Results:Mason type I fractures are treated non-operatively with splinting and early mobilisation. The management of Mason type II injuries is less clear with evidence supporting both non-operative treatment and internal fixation. The degree of intra-articular displacement and angulation acceptable for non-operative management has yet to be conclusively defined. Similarly the treatment of type III and IV fractures remain controversial. Traditional radial head excision is associated with valgus instability and should be considered only for patients with low functional demands. Comparative studies have shown improved results from internal fixation over excision. Internal fixation should only be attempted when anatomic reduction and initiation of early motion can be achieved. Authors have reported that results from fixation are poorer and complication rates are higher if more than three fragments are present. Radial head arthroplasty aims to reconstruct the native head and is indicated when internal fixation is not feasible and in the presence of complex elbow injuries. Overstuffing of the radiocapitellar joint is a frequent technical fault and has significant adverse effects on elbow biomechanics. Modular design improves the surgeon’s ability to reconstruct the native joint. Two randomised controlled trials have shown improved clinical outcomes and lower complication rate following arthroplasty when compared to internal fixation.Conclusion:We have presented details regarding the treatment of various types of radial head fractures - further evidence, however, is still required to provide clarity over the role of these different management strategies.

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Operative Management of Unstable Radial Head Fractures in a Young Active Population

Hand ◽

10.1177/1558944717715136 ◽

2017 ◽

Vol 13 (4) ◽

pp. 473-480 ◽

Cited By ~ 4

Author(s):

Nicholas Kusnezov ◽

Emmanuel Eisenstein ◽

John C. Dunn ◽

Austin Fares ◽

Justin Mitchell ◽

...

Keyword(s):

Upper Extremity ◽

Radial Head ◽

Operative Management ◽

Elbow Fracture ◽

Complication Rates ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Increased Risk ◽

Ligamentous Repair

Background: Radial head and neck fractures are the most common elbow fracture in the general adult population; however, the optimal treatment for radial head fractures remains a topic of ongoing clinical controversy. The purpose of this study was to determine the rate of return to function, complications, and reoperation following operative management of unstable radial head fractures in a young, active patient population with intense upper extremity demands. Methods: A military health care database was queried for all US military servicemembers undergoing open reduction with internal fixation (ORIF; Current Procedural Terminology [CPT] code: 24665) and radial head arthroplasty (RHA; CPT code: 24666) between 2010 and 2015. All patients with minimum 2-year follow-up were included. Univariate and chi-square analyses were performed to evaluate the association between potential risk factors and the primary outcome measures. Results: A total of 67 ORIF (n = 69 elbows) and 10 RHA patients were included. The average age was 31 ± 8.0 years. At mean follow-up of 3.5 ± 1.1 years, 90% of patients overall were able to return to active military service, 96% of which with unrestricted upper extremity function. Nearly one-third (31.2%) of patients developed at least 1 postoperative complication. RHA has higher overall complication rates (70% vs 48%) when compared with ORIF, but this finding did not reach statistical significance ( P = .073). However, RHA had significantly higher rates of implant failure (20% vs 2.9%, P = .0498). Seventeen (21%) individuals required reoperation, 5 of which (6.3%) were revision procedures. Dislocation, coronoid fracture, and concomitant ligamentous repair portended a significantly increased risk of sustaining 1 or more complications ( P < .05), while dislocation and requirement for ligamentous repair independently predicted revision surgery ( P < .05). Conclusions: Arthroplasty and ORIF are both viable options for treating unstable radial head fractures in a young, athletic population, offering comparable return to function despite increased complications with RHA.

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Extracorporeal Reconstruction of the Radial Head

Borneo Journal of Medical Sciences (BJMS) ◽

10.51200/bjms.vi.2399 ◽

2021 ◽

Author(s):

Kow Ren Yi ◽

Zaharul Azri Mustapha Zakaria ◽

Ruben Jaya Kumar ◽

Low Chooi Leng ◽

Khairul Nizam Siron Baharom

Keyword(s):

Internal Fixation ◽

Radial Head ◽

Radial Head Fracture ◽

Removal Rate ◽

Viable Option ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Type Iii ◽

Elbow Function ◽

Radial Head Excision

Radial head fractures are common in adults. The radial head acts as an important stabilizer of the radius, especially during the forearm pronation and supination. Surgical treatment of Mason type III fracture of the radial head includes radial head excision, radial head replacement and open reduction and internal fixation. For patients treated with radial head excision, the radius might migrate proximally, causing complications such as chronic pain at the wrist, forearm, and elbow. On the other hand, radial head arthroplasty is associated with a high revision and removal rate. Hence, openreduction and internal fixation are preferred when feasible. This is technically demanding due to the severe displacement of the radial head fragments and limited surgical space. Mr K, a 30-year-old manual worker sustained a closed right radial head fracture Mason type III after an alleged fall. The radial head was displaced anteriorly. Intra-operatively, the radial headpieces were retrieved and were reconstructed extracorporeal and fixed with a miniplate. The patient subsequently recovered with good function. The new technique of extracorporeal reconstruction of the radial head offers a viable option to the surgeon with similar, or even better, outcomes in terms of elbow function.

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Radial head fractures in young, active patients

Obere Extremität ◽

10.1007/s11678-020-00605-w ◽

2020 ◽

Vol 15 (4) ◽

pp. 251-259

Author(s):

Christopher G. Larsen ◽

Michael J. Fitzgerald ◽

Andrew S. Greenberg

Keyword(s):

Radial Head ◽

Young Patients ◽

Elbow Dislocation ◽

Early Mobilization ◽

High Energy ◽

Type I ◽

Type Ii ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Active Patients

AbstractThe radial head is an important stabilizer of the elbow joint. Radial head fractures are commonly associated with additional injuries to the ligamentous structures of the elbow and can significantly compromise elbow stability. Young patients with radial head fractures are more likely to be male and present after a high-energy mechanism of injury. While not perfect, the Mason classification is the most commonly used classification system and can help to guide the management of radial head fractures. Type I fractures are nondisplaced or minimally displaced (less than 2 mm) and are treated nonoperatively with early mobilization. Type II fractures, which are displaced 2–5 mm, can be treated nonoperatively or with open reduction and internal fixation (ORIF). Type III fractures are comminuted and are most often treated with ORIF or with radial head arthroplasty (RHA). Treatment of fractures with an associated elbow dislocation (Mason type IV) is also with ORIF or RHA depending on the degree of comminution. For all of these injuries, assessment and treatment of associated ligamentous injuries are necessary in conjunction with treatment of the bony injury. Despite a significant body of literature available on radial head fractures, there is controversy regarding the optimal management of type II, III, and IV fractures, especially in young, active patients. Common complications following radial head fractures include stiffness, instability, and posttraumatic osteoarthritis; as such, these injuries can lead to significant disability in young, active patients if not managed appropriately.

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KPS Bipolar Radial Head Arthroplasty – Polyethylene Head Replacement with a Metal-covered Head. Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0012.2133 ◽

2018 ◽

Vol 20 (3) ◽

pp. 229-237

Author(s):

Kamila Malesa ◽

Mariusz Urban ◽

Dariusz Michalik ◽

Stanisław Pomianowski

Keyword(s):

Clinical Outcome ◽

Internal Fixation ◽

Surgical Procedures ◽

Radial Head ◽

Open Reduction ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Radial Head Replacement ◽

Therapeutic Results

Radial head replacement should be indicated in all cases of radial head fractures when open reduction and internal fixation is anticipated to be difficult or impossible. Although excellent therapeutic results have been obtained, this procedure, like any other surgical procedures, may be associated with severe complications, including contractures, ossification or aseptic synovitis. In these cases, removal of the prosthetic radial head has always been a safe and popular solution producing a satisfactory clinical outcome. However, we present the case of a patient in whom the prosthesis was left in place, but the polyethylene head was replaced with a metal-covered head. The decision to perform this procedure was taken intraoperatively.

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Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-016-1739-1 ◽

2016 ◽

Vol 26 (3) ◽

pp. 283-291 ◽

Cited By ~ 19

Author(s):

Hao Sun ◽

Jun Duan ◽

Fengsheng Li

Keyword(s):

Internal Fixation ◽

Radial Head ◽

Open Reduction ◽

Meta Analysis ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Type Iii

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Open reduction and internal fixation versus radial head arthroplasty in the treatment of adult closed comminuted radial head fractures (modified Mason type III and IV)

International Orthopaedics ◽

10.1007/s00264-015-2755-1 ◽

2015 ◽

Vol 39 (8) ◽

pp. 1659-1664 ◽

Cited By ~ 16

Author(s):

Salah Al-Burdeni ◽

Yousef Abuodeh ◽

Talal Ibrahim ◽

Ghalib Ahmed

Keyword(s):

Internal Fixation ◽

Radial Head ◽

Open Reduction ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Type Iii

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Open Reduction and Internal Fixation Versus Radial Head Arthroplasty for Mason III Radial Head Fractures: Appraising the Current Literature Evidence

Cureus ◽

10.7759/cureus.7501 ◽

2020 ◽

Author(s):

Hannah Meacher ◽

Shady Hermena ◽

Sherif Isaac

Keyword(s):

Internal Fixation ◽

Current Literature ◽

Radial Head ◽

Open Reduction ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Literature Evidence

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Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant

Case Reports in Orthopedics ◽

10.1155/2018/7430297 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Patrick Lee ◽

Allison Z. Piatek ◽

Michael J. DeRogatis ◽

Paul S. Issack

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Open Reduction ◽

Humeral Fracture ◽

Humeral Shaft ◽

Proximal Ulna ◽

Elbow Injury ◽

Anatomic Reduction ◽

Elbow Injuries ◽

Floating Elbow

“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.

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