A Comparative Study Showing Elbow Kinematics in Radial Head Replacement Versus Radial Head Excision Versus Radial Head Fixation

Abstract

Background: Radial head fractures are quite common with incidence 1.5-4% of all adult fractures. The management of these fractures depends upon age and type of injury Aim: To compare the outcome in comminuted radial head fractures(Mason type III) based on mayo elbow scoring and handgrip strength test when managed with radial head excision, radial head fixation or radial head replacement Material and Methods: We did a prospective comparative study comprising 60 patients between age 20-60 years with Mason type III radial head fractures. The patients were randomised using the admission day of the week placing 20 patients each in arthroplasty , excision and in the fixation group. The patients were followed up for 18-24 months postoperatively. Results were evaluated by the Mayo’s elbow performance and Handgrip strength score at 6 months and 18 months and were statistically evaluated by one-way ANOVA test. Results: As per Mayo’s score at 6 months follow up, mean and standard deviation (SD) of the scores in arthroplasty was 83.25 and 11.50, for excision it was 76.25 and 11.38 & for fixation, it was 68.75 and 17.83 respectively. At 18 months follow up, mean and standard deviation was 90 and 12.56 for arthroplasty, 83 and 9.92 for excision & 76.25 and 21.69 for fixation respectively. As per handgrip strength score at 6 months follow up, mean and standard deviation of the scores in arthroplasty was 31.1 and 4.37, for excision it was 28.75 and 4.27 & for fixation, it was 27.15 and 5.94 respectively. At 18 months follow up, mean and standard deviation was 32.95 and 4.006 for arthroplasty, 30.7 and 4.06 for excision & 28 and 6.75 for fixation respectively. The difference between the results according to both Mayo’s score as well as Handgrip strength test was statistically significant (p < 0.05). Conclusion: Our study shows that long and short-term results of radial head replacement are better than radial head excision and radial head fixation in comminuted radial head fractures based on mayo elbow scoring and hand grip strength score. Keywords: Radial head fracture, Radial head replacement, Mason classification