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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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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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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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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