Background: Satisfactory internal fixation of comminuted radial head
fractures is often difficult to achieve, and radial head resection has been
the accepted treatment. In this study, we compared the results of radial head
resection with those of open reduction and internal fixation in patients with
a comminuted radial head fracture.
Methods: Twenty-eight patients with a Mason type-III radial head
fracture (some with associated injuries) were enrolled in the study. Fifteen
patients underwent radial head resection as the initial treatment (Group I),
and thirteen patients underwent open reduction and internal fixation (Group
II). The age at the operation averaged 41.1 and 38.2 years, respectively, and
the duration of follow-up averaged ten and three years, respectively. The
outcomes were assessed on the basis of pain, motion, radiographic findings,
and strength measured with Cybex testing. The overall outcome was rated with
the functional rating score described by Broberg and Morrey and with the
American Shoulder and Elbow Surgeons Elbow Assessment Form.
Results: Elbow motion averaged 15.5° (extension loss) to
131.4° (flexion) in Group I and 7.1° to 133.8° in Group II. The
carrying angle and ulnar variance averaged 8.2° and 1.9 mm in Group I and
1.5° and 0.5 mm in Group II. Compared with Group II, Group I had a loss of
strength in extension, pronation, and supination (p < 0.01). The Broberg
and Morrey functional rating score averaged 81.4 points in Group I and 90.7
points in Group II (p = 0.0034). The score on the American Shoulder and Elbow
Surgeons Elbow Assessment Form averaged 87.3 points in Group I and 94.6 points
in Group II (p = 0.0031).
Conclusions: The patients in whom the comminuted radial head
fracture was treated with open reduction and internal fixation had
satisfactory joint motion, with greater strength and better function than the
patients who had undergone radial head resection. These results support a
recommendation for open reduction and internal fixation in the treatment of
this fracture.
Level of Evidence: Therapeutic study, Level III. See
Instructions to Authors for a complete description of levels of evidence.