Arthroscopic surgery for radial head fractures: A prospective series of 9 cases

Abstract

Introduction The main complication of radial head fracture is elbow stiffness consequence of ligament injuries due to the trauma and those due to the surgery The aim of this study is to use an arthroscopic procedure for reduction and internal fixation: – enabling a complete diagnosis of ligament impairments (medial, volar, lateral); – sparing the collateral lateral and annular ligaments during the reduction and fixation. Materials and methods Over a 2-year period, 9 displaced fractures were operated with arthroscopy. We only retained recent Mason 2 & 3 fractures without dislocation. We used 3 portals, percutaneous cannulated screws, an antalgic splint for 3 weeks and an immediate active & passive physiotherapy. Physical examination and X-ray were done after 3, 6 and 12 weeks. Analysis criteria were: – perioperative: ligament impairment, time of surgery; – postoperative: motion, grasp strength, time without working and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results Time of surgery went down from 90 to 40 minutes; annular ligament was initially intact in 7/9 cases. Active range of motion was: – 3 weeks: F/E 90°, P/S 150°; – 6 weeks: F/E 110°, P/S 160°; – 12 weeks: F/E 120°, P/S 160°. We noticed 7 anatomic reductions (all Mason 2) and no secondary displacement. Time without working was 3 weeks (0–12). Discussion and conclusion Active motion was almost fully recovered after 6 weeks. The absence of secondary displacement suggests benefits of harder initial rehabilitation. Range of motion is at the minimum the same as other studies with shorter convalescence. None second time surgery was needed. Arthroscopic surgery for radial head fracture is a reliable and efficient procedure enabling rapid working and sports recovery.