Background: Moderately displaced two-fragment fractures of the
radial head have been treated predominantly nonoperatively. Recently, however,
open reduction and internal fixation has gradually gained interest, without
clear evidence that initial nonoperative treatment leads to an unfavorable
outcome. As a consequence, the purpose of the present study was to evaluate
the long-term outcome after the initial nonoperative treatment of this type of
fracture.
Methods: Fifteen men and thirty-four women, with a mean age of
forty-nine years at the time of the injury, were included in the study. All
patients initially had been managed nonoperatively for a two-fragment fracture
of the radial head that was displaced 2 to 5 mm and that included =30% of
the joint surface (a Mason type-IIa fracture). Early mobilization had been
used for twenty-seven patients, and cast immobilization for a mean of two
weeks (range, one to four weeks) had been used for twenty-two. All patients
were reevaluated with a questionnaire after a mean of nineteen years, and
thirty-four also had a clinical and a radiographic evaluation. Six patients
had had a delayed radial head excision because of an unsatisfactory primary
outcome.
Results: Forty of the forty-nine patients had no subjective
complaints, eight were slightly impaired as the result of occasional elbow
pain, and one had daily pain. Flexion was slightly impaired in the injured
elbows as compared with the uninjured elbows (137° ± 8°
compared with 139° ± 7°), as was extension (—3°
± 7° compared with 1° ± 5°) and supination (86°
± 7° compared with 88° ± 4°) (p < 0.05 for all
comparisons). The prevalence of degenerative changes on radiographs was higher
for the injured elbows than for the uninjured elbows (82% [twenty-eight of
thirty-four] compared with 21% [seven of thirty-four]; p < 0.01).
Conclusions: The initial nonoperative treatment of Mason type-IIa
fractures of the radial head that are displaced by 2 to 5 mm is associated
with a predominantly favorable outcome, especially if a delayed radial head
excision is performed in the few cases in which the early outcome is
unsatisfactory.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.