This retrospective study followed 24 patients with elbow dislocation plus radial head fracture (Mason Type IV injury) for a mean of 10 years. It asks how these fracture-dislocations should be managed and what long-term outcomes to expect. Outcomes were graded with an objective performance index covering motion, pain, strength, and stability.
Let the Mason type of the radial head fracture drive your plan for an elbow fracture-dislocation. For Type I or II fractures, reduce the elbow closed and start motion in the stable arc within two weeks. For a comminuted Type III, reduce and excise the radial head early, ideally within 24 hours.
The most actionable teaching point is the immobilization limit. Prolonged casting was the single factor most tied to poor results, and early motion did not produce late instability in any patient.
This counters the older instinct to protect a grossly unstable elbow with prolonged immobilization. The correct move is early motion plus close follow-up so that any early redislocation is caught and re-reduced. Remember this predates modern radial head arthroplasty and coronoid fixation, so its lessons on timing and mobilization matter more than its treatment specifics for today's terrible triad.
This retrospective study followed 24 patients with elbow dislocation plus radial head fracture (Mason Type IV injury) for a mean of 10 years. It asks how these fracture-dislocations should be managed and what long-term outcomes to expect. Outcomes were graded with an objective performance index covering motion, pain, strength, and stability.
Let the Mason type of the radial head fracture drive your plan for an elbow fracture-dislocation. For Type I or II fractures, reduce the elbow closed and start motion in the stable arc within two weeks. For a comminuted Type III, reduce and excise the radial head early, ideally within 24 hours.
The most actionable teaching point is the immobilization limit. Prolonged casting was the single factor most tied to poor results, and early motion did not produce late instability in any patient.
This counters the older instinct to protect a grossly unstable elbow with prolonged immobilization. The correct move is early motion plus close follow-up so that any early redislocation is caught and re-reduced. Remember this predates modern radial head arthroplasty and coronoid fixation, so its lessons on timing and mobilization matter more than its treatment specifics for today's terrible triad.