Retrospective cohort of 56 patients treated with ORIF for displaced radial head fractures, followed at average 48 months. Asks which fracture patterns — defined by fragment number and comminution — are genuinely amenable to fixation versus better served by excision or prosthetic replacement. Thirty had Mason Type-2 and twenty-six had Mason Type-3 fractures; 27 of 56 had associated fracture-dislocation.
Count the fragments before you commit to fixation. This paper establishes the three-fragment threshold that still guides radial head management today: three or fewer fragments supports ORIF, more than three favors excision with prosthetic replacement.
When you see a Mason Type-3 fracture intraoperatively and the head is in four or more pieces, the data are unambiguous — 13 of 14 patients failed with fixation attempted. Technically achieving reduction does not mean fixation will hold.
For comminuted Type-2 fractures, the associated injury pattern is the key question. An isolated comminuted Type-2 can be fixed; a comminuted Type-2 in the setting of elbow dislocation or Monteggia injury should prompt serious consideration of replacement if fixation feels tenuous.
This paper also reinforces why radial head preservation matters at all: the radial head is a primary stabilizer against valgus stress and axial load, and in unstable patterns like the terrible triad or Essex-Lopresti, radiocapitellar contact must be restored through either repair or arthroplasty.
Retrospective cohort of 56 patients treated with ORIF for displaced radial head fractures, followed at average 48 months. Asks which fracture patterns — defined by fragment number and comminution — are genuinely amenable to fixation versus better served by excision or prosthetic replacement. Thirty had Mason Type-2 and twenty-six had Mason Type-3 fractures; 27 of 56 had associated fracture-dislocation.
Count the fragments before you commit to fixation. This paper establishes the three-fragment threshold that still guides radial head management today: three or fewer fragments supports ORIF, more than three favors excision with prosthetic replacement.
When you see a Mason Type-3 fracture intraoperatively and the head is in four or more pieces, the data are unambiguous — 13 of 14 patients failed with fixation attempted. Technically achieving reduction does not mean fixation will hold.
For comminuted Type-2 fractures, the associated injury pattern is the key question. An isolated comminuted Type-2 can be fixed; a comminuted Type-2 in the setting of elbow dislocation or Monteggia injury should prompt serious consideration of replacement if fixation feels tenuous.
This paper also reinforces why radial head preservation matters at all: the radial head is a primary stabilizer against valgus stress and axial load, and in unstable patterns like the terrible triad or Essex-Lopresti, radiocapitellar contact must be restored through either repair or arthroplasty.