Functional Outcome of Open Reduction and Internal Fixation of Radial Head Fractures

Author Swapnil Keny
Co-Author Prashant kamble, Shubhranshu Mohanty, Tushar Rathod, Bhushan Hadole
DOI http://wwj

Country : India
Subject : Orthopaedics

Keywords : Radial head fracture, Open reduction and internal fixation, Functional outcome

Abstract

1.1 Background:
There is no consensus on the optimum management strategy for radial head fractures (Mason type II, III, IV). Open reduction and internal fixation, radial head arthroplasty and excision without replacement are the currently available treatment options for radial head fractures. We evaluated the radiological and functional outcome of cases with radial head fractures managed with open reduction and internal fixation at a tertiary care center.

1.2 Materials and Methods:
Between January 2016 and December 2018, 20 patients (12 males and 8 females; mean age 33.1 years) with radial head fractures underwent open reduction and internal fixation. These include 6-type II, 8-type III and 6-type IV injuries. The mean follow-up was 25 weeks (16-40 weeks). Patient assessment was done using the Mayo Elbow Performance Score (MEPS) and radiological parameters.

1.3 Results:
All patients showed radiographic union without any evidence of avascular necrosis, heterotrophic ossification or subluxation of distal radioulnar joint. The mean flexion at elbow joint was 130.25⁰ (Range: 120⁰ - 140⁰) and the mean loss of extension was -4.5⁰ (Range: 0⁰ to -15⁰). Mean pronation and supination of forearm were 71⁰ (Range: 60⁰ - 80⁰) and 75.5⁰ (Range: 70⁰ - 80⁰) respectively. According to the Mayo Elbow Performance score (MEPS), the outcome was excellent in 9 (45%), good in 10 (50%) and fair in one patient with the mean MEPS score of 87.25 (Range: 65-100). One patient with type IV injury required implant removal of broken trans-articular wire.

1.4 Conclusion:
We propose open reduction and internal fixation for the management of radial head fractures (Mason type II, III and IV) to achieve satisfactory clinical outcomes. Proper understanding of the fracture anatomy, early surgery, use of appropriate low-profile implants with excellent soft tissue repair and early mobilisation are the key steps in the management of these complex injuries.

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