Ring, J Bone Joint Surg Am 2002 - Open Reduction and Internal Fixation of Fractures of the Radial Head

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Open Reduction and Internal Fixation of Fractures of the Radial Head

Ring, Jupiter, et al.·J Bone Joint Surg Am·2002·496 citations·Retrospective cohort

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Background

The purpose of this retrospective study was to analyze the functional results following open reduction and internal fixation of fractures of the radial head and to determine which fracture patterns are most amenable to this treatment.

Methods

56 patients in whom an intra-articular fracture of the radial head had been treated with open reduction and internal fixation were evaluated at an average of 48 months after injury.
30 patients had a Mason Type-2 (partial articular) fracture, and 26 had a Mason Type-3 (complete articular) fracture.
27 of the 56 fractures were associated with a fracture-dislocation of the forearm or elbow or an injury of the medial collateral ligament.
15 of the 30 Type-2 fractures were comminuted.
14 of the 26 Type-3 fractures consisted of more than 3 fragments, and 12 consisted of 2 or 3 fragments.
The result at the final evaluation was judged to be unsatisfactory when there was early failure of fixation or nonunion requiring a second operation to excise the radial head, <100 degrees of forearm rotation, or a fair or poor rating according to the system of Broberg and Morrey.

Results

The result was unsatisfactory for 4 of the 15 patients with a comminuted Mason Type-2 fracture of the radial head; all 4 fractures had been associated with a fracture-dislocation of the forearm or elbow, and all 4 patients recovered <100 degrees of forearm rotation.
13 of the 14 patients with a Mason Type-3 comminuted fracture with more than 3 articular fragments had an unsatisfactory result.
In contrast, all 15 patients with an isolated, noncomminuted Type-2 fracture had a satisfactory result.
Of the 12 patients with a Type-3 fracture that split the radial head into 2 or 3 simple fragments, none had early failure, one had nonunion, and all had an arc of forearm rotation of > or =100 degrees.

Conclusions

Although current implants and techniques for internal fixation of small articular fractures have made it possible to repair most fractures of the radial head, our data suggest that open reduction and internal fixation is best reserved for minimally comminuted fractures with three or fewer articular fragments. Associated fracture-dislocation of the elbow or forearm may also compromise the long-term result of radial head repair, especially with regard to restoration of forearm rotation.

Copyright remains with the authors and publisher.

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Open Reduction and Internal Fixation of Fractures of the Radial Head

Ring, Jupiter, et al.·J Bone Joint Surg Am·2002·496 citations·Retrospective cohort

|

Background

The purpose of this retrospective study was to analyze the functional results following open reduction and internal fixation of fractures of the radial head and to determine which fracture patterns are most amenable to this treatment.

Methods

56 patients in whom an intra-articular fracture of the radial head had been treated with open reduction and internal fixation were evaluated at an average of 48 months after injury.
30 patients had a Mason Type-2 (partial articular) fracture, and 26 had a Mason Type-3 (complete articular) fracture.
27 of the 56 fractures were associated with a fracture-dislocation of the forearm or elbow or an injury of the medial collateral ligament.
15 of the 30 Type-2 fractures were comminuted.
14 of the 26 Type-3 fractures consisted of more than 3 fragments, and 12 consisted of 2 or 3 fragments.
The result at the final evaluation was judged to be unsatisfactory when there was early failure of fixation or nonunion requiring a second operation to excise the radial head, <100 degrees of forearm rotation, or a fair or poor rating according to the system of Broberg and Morrey.

Results

The result was unsatisfactory for 4 of the 15 patients with a comminuted Mason Type-2 fracture of the radial head; all 4 fractures had been associated with a fracture-dislocation of the forearm or elbow, and all 4 patients recovered <100 degrees of forearm rotation.
13 of the 14 patients with a Mason Type-3 comminuted fracture with more than 3 articular fragments had an unsatisfactory result.
In contrast, all 15 patients with an isolated, noncomminuted Type-2 fracture had a satisfactory result.
Of the 12 patients with a Type-3 fracture that split the radial head into 2 or 3 simple fragments, none had early failure, one had nonunion, and all had an arc of forearm rotation of > or =100 degrees.

Conclusions

Although current implants and techniques for internal fixation of small articular fractures have made it possible to repair most fractures of the radial head, our data suggest that open reduction and internal fixation is best reserved for minimally comminuted fractures with three or fewer articular fragments. Associated fracture-dislocation of the elbow or forearm may also compromise the long-term result of radial head repair, especially with regard to restoration of forearm rotation.

Copyright remains with the authors and publisher.

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