Background: The reported long-term outcomes of the treatment of
radial head and neck fractures with excision of the radial head have been
mixed. The purpose of the present study was to evaluate the long-term outcomes
of primary or delayed radial head excision for the treatment of these
fractures.
Methods: Sixty-one individuals (mean age, forty-four years) with
thirty-nine Mason type-II, ten Mason type-III, and twelve Mason type-IV
fractures were evaluated subjectively, objectively, and radiographically at a
mean of eighteen years (range, eleven to thirty-three years) after treatment.
Forty-three fractures were treated with primary radial head excision, and the
remaining eighteen were treated with delayed radial head excision at a median
of five months (range, one to 238 months) after the injury.
Results: At the time of follow-up, twenty-eight individuals had no
symptoms, twenty-seven had occasional elbow pain, and six had daily pain. Four
individuals with daily pain had had a Mason type-IV fracture. The range of
motion of the formerly injured upper extremities was slightly less than that
of the uninjured upper extremities in terms of flexion (139° ±
11° compared with 142° ± 8°), extension (—7°
± 12° compared with —1° ± 6°), and supination
(77° ± 20° compared with 85° ± 10°) (all p <
0.01). A higher percentage of formerly injured elbows than uninjured elbows
had cysts, sclerosis, and osteophytes (73% compared with 7%; p < 0.001),
but none had a reduced joint space. No differences were found between the
outcomes for individuals treated with a primary radial head excision and those
for individuals treated with a delayed excision.
Conclusions: Following a displaced radial head or neck fracture,
excision of the radial head often leads to a good or fair result. We found no
differences in outcome between primary and delayed radial head excisions
following a Mason type-II, III, or IV fracture. The outcomes are associated
with the type of fracture, with Mason type-IV fractures having the worst
results, rather than with the timing of the radial head excision (primary or
delayed).
Level of Evidence: Therapeutic study, Level III-2
(retrospective cohort study). See Instructions to Authors for a complete
description of levels of evidence.