Journal List > J Korean Fract Soc > v.32(4) > 1138757

Lee, Kim, Kim, and Han: Open Reduction and Internal Fixation in Comminuted Radial Head Fracture

Abstract

Purpose

Radial head fractures, which account for 33% of all fractures, are treated depending on the Mason classification. In comminuted type 3 fractures, open reduction internal fixation (ORIF), and radial head arthroplasty are the treatment options. This study examined the clinical outcome of modified Mason type 3 radial head fractures using ORIF with a plate.

Materials and Methods

The medical records and image of 33 patients, who underwent ORIF for modified Mason type 3 radial head fractures, were reviewed retrospectively. The preoperative plain radiographs and computed tomography images were used to examine the location of the fracture of the radial head, the number of fragments, union, joint alignment, and traumatic arthritis at the final followup. The range of motion (ROM) of the elbow at the last follow-up, pain score (visual analogue scale), modified Mayo elbow score (MMES), and complications were analyzed for the clinical outcome.

Results

Of the 33 cases, 14 were men and 19 were women. The mean age was 41.8 years and the average follow-up period was 19 months. The functional ROM was divided into three groups according to the number of bone fragments: 141.2°±9.3° of 3 (n=20), 123.8°±18.5° of 4 (n=7), 100.7°±24.4° of more than 4 (n=6). Furthermore, the MMES were 88.2±2.9, 83.7±4.3, and 77.3±8.4, respectively (p=0.027). Depending on the radial head fracture location, the ROM and MMES were 130.7°±7.5° and 82.1±4.7, respectively, with poor outcomes on the ulnar aspect compared to 143.1°±3.8° and 89.9±3.2 on the radial aspect.

Conclusion

Various factors, such as the degree of crushing and location involved in the clinical outcome. In particular, the result was poor in the case of more than four comminuted fragments or chief position located in the ulnar aspect. In this case, radial head arthroplasty may be considered in the early stages.

References

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Fig. 1.
Radiologic assessment of the fracture pattern. R: radial side, U: ulnar side.
jkfs-32-173f1.tif
Fig. 2.
A 57-year-old man sustained a comminuted radial head fracture of the right elbow after a fall from a 1 m height. (A-C) The plain X-ray and three-dimensional computed tomographic scans detected anterior aspect radial head fracture with three fragmentation. (D, E) Open reduction and plate fixation were carried out and solid union was achieved.
jkfs-32-173f2.tif
Fig. 3.
Despite the small heterotrophic ossification at postoperative one year, the functional result was favorable with a range of motion (extension-flexion: 0°-130°, pronation-supination: 80°-80°) and 95 of the modified Mayo elbow score.
jkfs-32-173f3.tif
Fig. 4.
(A, B) A 55-year-old woman fell on the ground with an outstretched hand and was diagnosed with a radial head fracture on the left elbow at the initial X-ray. (C, D) The three-dimensional computed tomographic scans revealed multi-fragmentary, five fragments, a radial head fracture with displacement in the overall radial head.
jkfs-32-173f4.tif
Fig. 5.
Open reduction and internal fixation were conducted (A, B), but a postoperative 1 year, the patient presented with partial fragment nonunion (C, D). The range of motion was 10° to 120° flexion and the modified Mayo elbow score was 80.
jkfs-32-173f5.tif
Table 1.
Baseline Data of the Patients
Variable Value
Gender  
Men 14 (42.4)
Women 19 (57.6)
Mean age (yr) 41.8 (19–72)
Injured dominant arm 11 (33.3)
Mean duration for operation (d) 2.72 (1–5)
Mean duration for ROM after operation (wk) 3.52 (1–8)
Follow-up period (mo) 19 (12–36)
Injury mechanism  
Falling from ground level 18 (54.6)
Falling from height 12 (36.4)
Traffic accident 1 (3.0)
Stuck in door 1 (3.0)
Injured from ski 1 (3.0)

Values are presented as number (%) or mean (range). ROM: range of motion.

Table 2.
Overall Functional Outcome
Variable Value
Mean flexion (°) 133.5 (90–150)
Mean extension (°) 6.2 (0–40)
Mean pain VAS 1.37 (0–4)
Modified Mayo elbow score 87.1 (70–95)

Values are presented as mean (range). VAS: visual analogue scale.

Table 3.
Functional Outcomes Depending on the Number of Fracture Fragments
Variable Group 1* (n=20) Group 2* (n=7) Group 3* (n=6) p-value
Operation time (min) 61.9±26.9 87.9±31.7 82.9±9.9 0.005
Range of motio n (°) 141.2±9.3 123.8±18.5 100.7±24.4 0.001
MMES 88.2±2.9 83.7±4.3 77.3±8.4 0.027

Values are presented as mean±standard deviation. *Group 1: 3 fragments, Group 2: 4 fragments, Group 3: ≥5 fragments. MMES: modified Mayo elbow score.

Table 4.
Functional Outcome Depending on the Main Fracture Location
Variable Radial side Ulnar side p-value
Operation time (min) 63.4±20.7 87.1±30.1 0.026
Range of motion (°) 143.1±3.8 130.7±7.5 0.87
MMES 89.9±3.2 82.1±4.7 0.109

Values are presented as mean±standard deviation. MMES: modified Mayo elbow score.

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