Journal of Musculoskeletal Trauma

Open Reduction and Internal Fixation in Comminuted Radial Head Fracture: Jun Ku Lee, Tae Ho Kim, Choongki Kim, Soo Hong Han; J Korean Fract Soc 2019;32(4):173-180. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.173

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 follow-up. 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: 141.2Â°Â±9.3Â° of 3 (n=20), 123.8Â°Â±18.5Â° of 4 (n=7), 100.7Â°Â±24.4Â° of more than 4 (n=6). Furthermore, the MMES were 88.2Â±2.9, 83.7Â±4.3, and 77.3Â±8.4, respectively (p=0.027). Depending on the radial head fracture location, the ROM and MMES were 130.7Â°Â±7.5Â° and 82.1Â±4.7, respectively, with poor outcomes on the ulnar aspect compared to 143.1Â°Â±3.8Â° and 89.9Â±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.

Citations

Citations to this article as recorded by

Does the coronoid fracture in terrible triad injury always need to be fixed?
Yeong-Seub Ahn, Seong-Hwan Woo, Sungmin Kim, Jun-Hyuk Lim, Tae-Hoon An, Myung-Sun Kim
BMC Surgery.2024;[Epub] CrossRef
Results of the Use of Bioabsorbable Magnesium Screws for Surgical Treatment of Mason Type II Radial Head Fractures
Chul-Hyung Lee, Seungha Woo, Hyun Duck Choi
Clinics in Orthopedic Surgery.2023; 15(6): 1013. CrossRef

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The Short Term Results of Radial Head Arthroplasty with Unipolar Loose Fit Stem: Su Keon Lee, Kyeong Seop Song, Seung Hwan Lee, Sang Pil Yoon, Sang Youn Lim; J Korean Fract Soc 2015;28(2):125-131. Published online April 30, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.2.125

Abstract PDF: PURPOSE
We report short-term results of radial head prosthesis using a unipolar loose fit stem in ten patients.
MATERIALS AND METHODS
Ten patients with Mason type three radial head fracture, who received unipolar radial head arthroplasty from February 2010 to June 2011, were evaluated (mean follow-up: 22 months, range: 18-30 months). Subjects consisted of five men and five women. Range of elbow motion was measured. Mayo elbow performance index (MEPI) score was used for functional evaluation and periodic radiological imaging was performed to evaluate the stability of implant.
RESULTS
After an average follow-up of 22 months, elbow stability was maintained in all cases, and the average range of motion of elbow flexion and extension was 6 to 130 degrees. Average range of pronation and supination was 66 and 74 degrees, respectively. MEPI score was evaluated as excellent in seven cases, and good in three cases. On final follow-up, radiological assessment showed implant stability in all cases without evidence of dislocation, subluxation, arthritis, periprosthetic osteolysis or heterotopic ossification.
CONCLUSION
Based on our short-term follow-up, radial head arthroplasty with unipolar loose fit stem is a useful method for obtaining satisfactory outcome for unreducible comminuted radial head fractures.

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The Operative Treatment of Radial Head or Neck Fracture: The Sub-classification of Mason Type II Fracture: Hyun Dae Shin, Kyung Cheon Kim, Se Min Woo, Yong Bum Joo, Dong Kyu Kim; J Korean Fract Soc 2006;19(4):449-453. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.449

Abstract: PURPOSE
To evaluate the results of treatment according to the sub-classification of the Mason type II fracture.
MATERIALS AND METHODS
From 1999 to 2003, according to the sub-classification of the Mason type II fracture, 33 patients were treated with miniplate in displaced neck fracture (IIa), with compression screw in displaced head fracture (IIb), with miniplate and/or compression screw in displaced head and neck fracture (IIc), with compression screw and miniplate in comminution fracture (III) or excision of head in irreducible state. The clinical results were evaluated by An and Morrey's functional rating index.
RESULTS
Functional rate score averaged 92.7 in type IIa, 88.4 in IIb, 86.4 in IIc, 83.5 in type III with reduced fracture, 75.0 in type III with excised head, and 75.5 in type IV. Complications included heterotopic ossification (2 cases), metal loosening (1 case), malunion (1 case), partial ankylosis of elbow (3 cases), posttraumatic arthritis (1 case).
CONCLUSION
These results supported the recommendation for internal fixation with compression screw in isolated radial head fracture (IIb) and with miniplate in fracuture combined with displaced neck (IIa, IIc, indicated some III). We concluded that sub-classification is useful for dicision making in radial head or neck fracture's treatment.

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Elbow Dislocation Combined with Coronoid Process and Radial Head Fracture: Sung Tae Lee, Jin Hyung Choi, Joong Bae Seo, Jin Young Park; J Korean Fract Soc 2005;18(4):437-442. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.437

Abstract PDF: PURPOSE
To evaluate the clinical outcome for terrible triad injury of the elbow joint. MATERIAL AND METHODS: We reviewed consecutive 10 cases retrospectively among 12 terrible triad injuries, which had been followed up for a minimum 1 year. The average age at the time of injury was 45 years (range, 32~72). All cases were dislocated posteriorly. The 3 cases had fracture of olecranon. Combined medial and lateral approach was performed in 3 cases, medial and lateral approach after extensile posterior approach in 4 cases, transolecranon approach using existed olecranon fracture in 2 cases, and transolecranon approach in 1 case were done.
RESULTS
The average Mayo elbow performance score was 87, with 5 excellent, 4 good, and 1 poor results. Results by Riseborough and Radin's rating criteria include 9 good and 1 fair. The 8 cases were stable. But 2 cases were classified with moderate and severe instability; these cases had been performed by radial head allograft and excision respectively.
CONCLUSION
A stable, functional elbow can be restored in terrible triad injury by early active rehabilitation after anatomic reduction and firm internal fixation.

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Fracture of the Medial Epicondylar Apophysis of Distal Humerus with Subluxation of the Radial Head: A Case Report: Han Yong Lee, Kee Won Rhyu, Jin Young Jeong, Joo Hyoun Song, Hae Seok Koh, Yong Koo Kang, Mun Ik Sohn; J Korean Soc Fract 2003;16(2):304-307. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.304

Abstract PDF: It has been known that fracture of medial epicondylar apophysis of distal humerus may be isolated or associated with elbow dislocations. We have experienced a case which medial epicondylar fracture of the distal humerus was associated with subluxation of the radial head. Initially, we had tried reduction of subluxated radial head by closed method, but failed. Finally open reduction had been performed. At 6 month after open reduction, clinical and radiological result were excellent. As it is difficult for those associated injuries to occur simultaneously and the similar cases never have been reported yet, we would like to present this case with a review of the literature.

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Comparison of radial head excision and open reduction & internal fixation for comminuted radial head & neck fracture: Jae Gune Jun, Chul Hyung Lee, Sung Jun Han, Sang Seon Lee, Won Tae Choi, Ho Rim Choi, Jeong Woung Lee; J Korean Soc Fract 2001;14(1):106-112. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.106

Abstract PDF: PURPOSE
The goals of the present study were to compare of radial head excision and open reduction k internal fixation for comminuted radial head & neck fracture.
MATERIALS AND METHODS
From march 1993 to February 1999, Patients with fracture of radial head (Mason type III) who were treated at Dae-Jeon Sun General hospital were enrolled in the study. The average duration of follow up was 3 years and 3 months. Six patients(Group A) were treated with radial head excision and fourteen patients(Group B) were treated with open reduction and internal fixation.
RESULTS
By functional rating index(modified After B.F. Morrey et al), in Group A, the results were classified as excellent(1 patient), good(No patient), fair(2 patients), and poor(3 patients), and in Group B, excellent(4 patients), good(5 patients), fair(3 patients), and poor(2 patients).
CONCLUSION
We concluded clinically to obtain better outcome in group which were treated with open reduction and internal fixation than radial head excision. Therefore, though the treatment of choice for Mason type III radial head fracture was total excision, in consideration of complication, procedure to preserve radial head was desirable. We must give careful consideration to possibility of open reduction and decision of radial head excision.

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Reconstruction of Neglected Traumatic Radial Head Dislocation in Children: Dong Yeon Lee, Tae Joon Cho, In Ho Choi, Chin Youb Chung, Young Jin Sohn; J Korean Soc Fract 2000;13(4):1024-1032. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1024

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the clinical result of surgical reconstruction of the old traumatic radial head dislocation in children, and to delineate the optimal surgical procedure for it.
MATERIALS AND METHODS
Fifteen cases of the old traumatic radial head dislocation were included in this study, which had surgical reconstruction at the age of 15 years or less. Preoperative and postoperative clinical symptom, range of joint motion, and radiologic findings were reviewed. Reconstructions were performed by combination of various procedures, and the advantages and disadvanges of each procedures were analyzed.
RESULTS
All the preoperative complaints were relieved by the operation. In twelve cases out of 15, the radial head reduction was well maintained. The reasons for the loss of reduction were non-union of ulnar osteotomy site, and the neglected angular deformity at the proximal radius. Although forearm pronation was decreased in most cases, they did not affect most of the daily activities except in cases where the radioulnar osseocartilaginous bridge were complicated.
CONCLUSION
Our results justify the surgical reconstruction of neglected traumatic radial head dislocations in children. Complete clearing of radiocapitellar joint, accurate bony realignment and rigid fixation, appropriate annular ligament reconstruction, and temporary fixation with transcapitellar pin may ensure satisfactory result.

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Radial Head Dislocation With Ipsilateral Radial Shaft Fracture: A Case Report: Keun Woo Kim, Yong Hoon Kim, Hak Jin Min, Ui Seoung Yoon, Hee Oh Kim, Jae Hee Kim; J Korean Soc Fract 2000;13(3):570-575. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.570

Abstract PDF

Radial head dislocation with ipsilateral radial shaft fracture is one of the reportable trauma case with very low incidence. Only 4 cases of this type injury have been reported worldwide. In 3 cases of them, good results were achieved after early closed reduction of the radial head, followed by internal fixation of the radial shaft. In the a u t h o r s'case, the patient received the same method of treatment mentioned at the previous successful 3 cases. But after that, he suffered from repeated dislocations and finally nonunion of the fracture. At last, the authors could obtain bony union and stable elbow joint after radial head resection and osteosynthesis using autologous cancellous bone graft, but resulted in limitation of motion. We report the case and the experience of treatment.

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Delayed radial head dislocation after radial shaft fracture fixation: a case report and review of the literature
Jiyong Yang, Jie Zhang, Zhengzhong Yang
BMC Surgery.2022;[Epub] CrossRef

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Results of Treatment of Fracture-Dislocations of Elbow: Dong Soo Kim, Soon Ho Hwang, Chil Soo Kwon, Jong Kuk Ahn, Byung Hyun Jung, Yerl Bo Sung, Jae Kwang Yum, Hyung Jin Chung; J Korean Soc Fract 2000;13(1):178-185. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.178

Abstract PDF: PURPOSE
: This study analyzed clinical and biomechanical data from patients with elbow fracture dislocation to correlate long-term objective result with the specific injury type and treatment rendered. This can provide a basis for the management of this difficult injuries.
MATERIALS AND METHODS
: Fifteen patients with elbow dislocation were studied from October, 1992 to October, 1997 in Sang-Gye Paik Hospital. The average duration of follow up was 4.2 years.
RESULTS
: On the basis of an objective functional grading score that included elements of pain, motion, strength, and stability, the results were excellent in five(33%), good in five(33%), fair in one(7%), poor in four(27%). Prolonged immobilization greater than four weeks was associated with poor results. The results were closely related to the combined injuries and duration of immobilization. In case of radial head fractures, the best result was obtained in patients with Mason type II fractures treated by open reduction and internal fixation using Herbert screw and early complete radial head excision. SUMMARY AND CONCLUSION : The most common combined injury is radial head fracture. Early complete radial head excision and encouraging early ROM had more satisfactory result than delayed radial head excision or internal Fixation for Mason type III fracture.

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Open Reduction and AO Miniscrew Fixation of Displaced Radial Head Fractures in Adults: Jae Do Kang, Kyung Chil Jung, Chi Wook Kyoung; J Korean Soc Fract 2000;13(1):146-151. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.146

Abstract PDF: PURPOSE
: To analyze the results of open reduction and AO miniscrew fisation in displaced radial head fractures in adults. Materials & Methods : We analyzed 10 cases of displaced radial head fractures who were operated with open reduction and AO miniscrew fixation from January 1996 to March 1998. All of the fractures were classified in the Mason classification. The functional rating index was used in follow-up assessment.
RESULTS
: Average flexion was 143.5degrees, and the mean fixed flexion deformity was 3.5 degrees. The average elbow score was 95.6 points Good or excellent results were achieved in 100%. No patient had evidence of valgus instability.
CONCLUSION
: We concluded that open reduction and internal fixation in Mason type II and reparable Mason type III radial head fractures gives satisfactory range of motion and stability in the elbow joint. We suggest that anatomical reduction of fracture fragments, rigid fixation, early mobilization and proper implant placement are important for the restoration of the elbow function

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Bioresorbable Implant Fixation for the Treatment of Radial Head and Neck Fractures: Coo Hyun Baek, Young Jin Sohn, Choon ki Lee, Moon Sang Chung; J Korean Soc Fract 1998;11(1):70-77. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.70

Abstract PDF: Between March 1988 and March 1995, 10 patients with displaced Mason type II, type III, or type IV fracture of the radial head or neck were treated by open reduction and internal fixation using bioresorbable pins. The average age of the patients was 38 years (22 to 70), and average follow-up period eas 14 months (12 to 18). There were 4 type II, 4 type III, and 2 type IV fractures. According to the functional rating system of Broberg and Morrey, the clinical results were reviewed at an average follow-up of 14 months. The functional results were 4 excellent, 5 good, and 1 fair. Fixation of displaced radial head or neck fracture using bioresorbable pins, was considered as one of the good methods.

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Swanson Prosthesis Replacement of the Comminuted Radial Head Fracture Associated with Posterior Dislocation of the Elbow: 3 Cases Experienced: Soo Kyoon Rah, Jin Il Kim, Chi Soo Sohn, Yon Il KIm, Chang Uk Choi; J Korean Soc Fract 1998;11(1):47-55. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.47

Abstract PDF: Radial head resection is the accepted treatment of comminuted radial head fractures in adults, but the results are not always satisfactory. a number of well-known problems can ensue. These include chronic elbow and wrist pain, limited of motion, cubitus valgus, proximal radial migration, and new bone formation at the site of excision. Prosthetic replacement of radial head after excision offers theoretical advantages in the prevention of these problems. We are reporting three cases of patients, who had treated Swanson silastic prosthesis after comminuted radial head fracture associated posterior dislocation of the elbow.

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Operative Treatement of Comminuted Fracture of the Radial Head: Sang Don Jeong, Jeong Woong Lee, Jin Hong Rhee, Jae Yeong Cho, Seog Hyun Yoon, Sang Won Bae, Eui Hyoung Lee; J Korean Soc Fract 1997;10(1):127-132. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.127

Abstract PDF: It has been controversial to decide the proper management for the comminuted fracture of the radial head. For the management of this fracture, there are various methods such as resection of radial head, inserion of radial head implant, and open reduction and internal fixation, etc. The resection of radial head which has been performed by the majority of surgeons, could bring several complications; chronic pain in the elbow, cubitus valgus, new bone formation at site of excision and proximal migration of the radius with late subluxation of the distal radioulnar joint. Therefore the importance of radial head has been recognized recently. Authors have had good results in 6 patients who undergone open reduction and internal fixation for severely comminuted fracture of the radial head.

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Silicone Rubber Replacement of the Severely Fractured Radial Head: Byung Woo Min, Chang Soo Kang, Young Sik Pyun, Kwang Soon Song, Young Wook Ha; J Korean Soc Fract 1994;7(1):43-48. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.43

Abstract PDF: The best method of treatment for displaced comminuted fractures of the radial head is still controversial. Early excision of the fractured radial head has been favored by a number of authors. but problems such as chronic pain in the elbow, forearm or wrist, restricted movement of the elbow, late subluxation of the distal radio-ulnar joint can ensue. So prosthetic replacement of the radial head had been advocated either for acute treatment of a fracture or for delayed treatment, when conservative treatment has failed. We analyzed 10 patients with comminuted radial head fracture treated by silastic prosthesls replacement shortly after injury from Jan. 1988 to Dec. 1992. The results were as follows. 1. Age distribution at operation was varied from 19 to 57 year with the average at 40.9 year. 2. The average time interval between initial radial head fracture and silastic prosthetic replacement was about 10 days(range 4 days to 18 days). 3. 6 patients(60%) were free of elbow, pain 2 patients(20%) had intermittent mild pain especially at night and 2 patients(20%) had mild pain only after heavy work. 4. All patients were free of wrist pain 5. There was no patient of breaking or tilting of prosthesis radiologically. 6. Overall assessment showed excellent in 4 patients(40%), good in 4 patients(40%) and poor in 2 patients(20%).

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Herbert screw fixation of fracture of the radial head and capitellum: Ik Dong Kim, Joo Chul Ihn, Poong Taek Kim, Byung Chul Park, Young Goo Lyu, Il Hyung Park, Koo Hee Lee; J Korean Soc Fract 1991;4(2):356-361. Published online November 30, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.2.356

Abstract PDF: No abstract available.

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