Open Reduction and Internal Fixation in Comminuted Radial Head Fracture

Jun Ku Lee; Tae Ho Kim; Choongki Kim; Soo Hong Han

doi:10.12671/jkfs.2019.32.4.173

Articles

Page Path: HOME > J Musculoskelet Trauma > Volume 32(4); 2019 > Article

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

¹Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea.

²Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea. hsoohong@cha.ac.kr

prev next

263 Views
1 Download
2 Crossref
0 Scopus

prev next

Full Article

Download PDF

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 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.

Keywords: Radial head fractures, Fracture fragment, Fracture location, Internal fixation

J Korean Fract Soc. 2019 Oct;32(4):173-180. Korean.
Published online Oct 28, 2019.
https://doi.org/10.12671/jkfs.2019.32.4.173

Original Article

Open Reduction and Internal Fixation in Comminuted Radial Head Fracture

Jun-Ku Lee

, M.D., Tae-Ho Kim

, M.D.,^* Choongki Kim

, M.D. and Soo-Hong Han

, M.D., Ph.D.^*

Author information

Author notes

- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea.
- ^*Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Correspondence to: Soo-Hong Han, M.D., Ph.D. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: +82-31-780-5289, Fax: +82-31-708-3578, Email: hsoohong@cha.ac.kr

Received March 16, 2019; Revised May 13, 2019; Accepted August 19, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 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: 141.2°±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.

Keywords

Radial head fractures, Fracture fragment, Fracture location, Internal fixation

Figures

Fig. 1
Radiologic assessment of the fracture pattern. R: radial side, U: ulnar side.

Download Figure

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.

Download Figure

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.

Download Figure

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.

Download Figure

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.

Download Figure

Tables

Table 1
Baseline Data of the Patients

Download Table

Table 2
Overall Functional Outcome

Download Table

Table 3
Functional Outcomes Depending on the Number of Fracture Fragments

Download Table

Table 4
Functional Outcome Depending on the Main Fracture Location

Download Table

Notes

Financial support:None.

Conflict of interests:None.

References

1. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 1954;42:123–132.
1. Ring D. Elbow fractures and dislocations. In: Rockwood CA, Green DP, Court-Brown CM, Heckman JD, McQueen MM, editors. Rockwood and Green's fractures in adults. Philadelphia, Baltimore, New York: Lippincott Williams & Wilkins; 2015. pp. 905-944.
1. Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 1962;31:51–56.
1. King GJW. Fractures of the radial head. In: Cohen MS, Green DP, Hotchkiss RN, Kozin SH, Pederson WC, Wolfe SW, editors. Green's operative hand surgery. Philadelphia: Elsevier; 2017. pp. 734-770.
1. Burkhart KJ, Wegmann K, Müller LP, Gohlke FE. Fractures of the radial head. Hand Clin 2015;31:533–546.
1. Johansson O. Capsular and ligament injuries of the elbow joint. A clinical and arthrographic study. Acta Chir Scand Suppl 1962;Suppl 287:1–159.
1. Itamura J, Roidis N, Mirzayan R, Vaishnav S, Learch T, Shean C. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg 2005;14:421–424.
1. Fowler JR, Goitz RJ. Radial head fractures: indications and outcomes for radial head arthroplasty. Orthop Clin North Am 2013;44:425–431. x.
1. Lindenhovius AL, Felsch Q, Doornberg JN, Ring D, Kloen P. Open reduction and internal fixation compared with excision for unstable displaced fractures of the radial head. J Hand Surg Am 2007;32:630–636.
1. Crönlein M, Zyskowski M, Beirer M, et al. Using an anatomically preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 2017;137:789–795.
1. Hotchkiss RN. Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg 1997;5:1–10.
1. Wu PH, Shen L, Chee YH. Screw fixation versus arthroplasty versus plate fixation for 3-part radial head fractures. J Orthop Surg (Hong Kong) 2016;24:57–61.
1. Tarallo L, Mugnai R, Rocchi M, Capra F, Catani F. Mason type III radial head fractures treated by anatomic radial head arthroplasty: is this a safe treatment option? Orthop Traumatol Surg Res 2017;103(2):183–189.
1. Ruan HJ, Fan CY, Liu JJ, Zeng BF. A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III. Int Orthop 2009;33:249–253.
1. Sun H, Duan J, Li F. Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a metaanalysis. Eur J Orthop Surg Traumatol 2016;26:283–291.
1. Geel CW, Palmer AK, Ruedi T, Leutenegger AF. Internal fixation of proximal radial head fractures. J Orthop Trauma 1990;4:270–274.
1. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 2002;84:1811–1815.
1. Ruchelsman DE, Christoforou D, Jupiter JB. Fractures of the radial head and neck. J Bone Joint Surg Am 2013;95:469–478.

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

PubReader

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Open Reduction and Internal Fixation in Comminuted Radial Head Fracture

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

Related articles

Usefulness of Reduction and Internal Fixation Using a 2.4 mm Hand Plating System in Type AO 33-A3 Distal Femur Fracture - Technical Note -