This retrospective study by Broberg and Morrey asked whether delayed radial head excision is a viable salvage procedure after failed nonoperative management of Mason type-II and III fractures. 21 patients underwent excision between 1 month and more than 20 years after fracture, with mean follow-up of 15 years. The study directly tested the then-unproven assumption that underlies conservative management: that late excision works if nonoperative treatment fails.
5 years: 100%
Prior to this paper, the accepted dogma — based on small anecdotal series. Was that radial head excision must be performed within days of injury, and that late resection was largely futile. Authors like Radin and Riseborough had condemned delayed excision based on just three patients with poor results.
This study flips that teaching. For a Mason type-II or III fracture failing nonoperative management, delayed excision remains a viable option whether you are operating 3 months or 10 years after the original injury. When you see a patient in clinic with persistent radiohumeral pain and limited motion after a conservatively managed radial head fracture, do not assume the window for surgery has closed.
One critical caveat: results are only predictable when pain localizes specifically to the radiohumeral joint. If the patient has established ulnohumeral arthrosis, excision will not help. In type-IV injuries (radial head fracture with elbow dislocation), defer excision at least 3 months to allow the stabilizing structures to heal before removing the radial head.
This retrospective study by Broberg and Morrey asked whether delayed radial head excision is a viable salvage procedure after failed nonoperative management of Mason type-II and III fractures. 21 patients underwent excision between 1 month and more than 20 years after fracture, with mean follow-up of 15 years. The study directly tested the then-unproven assumption that underlies conservative management: that late excision works if nonoperative treatment fails.
5 years: 100%
Prior to this paper, the accepted dogma — based on small anecdotal series. Was that radial head excision must be performed within days of injury, and that late resection was largely futile. Authors like Radin and Riseborough had condemned delayed excision based on just three patients with poor results.
This study flips that teaching. For a Mason type-II or III fracture failing nonoperative management, delayed excision remains a viable option whether you are operating 3 months or 10 years after the original injury. When you see a patient in clinic with persistent radiohumeral pain and limited motion after a conservatively managed radial head fracture, do not assume the window for surgery has closed.
One critical caveat: results are only predictable when pain localizes specifically to the radiohumeral joint. If the patient has established ulnohumeral arthrosis, excision will not help. In type-IV injuries (radial head fracture with elbow dislocation), defer excision at least 3 months to allow the stabilizing structures to heal before removing the radial head.