Clinical efficacy of open reduction and internal fixation plus radial head resection in treatment of radial head fractures

Abstract

Objective To investigate the prognostic outcome of open reduction and internal fixation(ORIF)with radial head resection in treatment of comminuted radial head fractures so as to discuss the corresponding operation options.Methods A series of 23 patients with Mason type Ⅲ or Ⅳ radial head fractures were enrolled in the study including 11 males and 12 females.Eight patients(three with Mason type Ⅲ and five with Mason type Ⅳ)underwent radial head resection and 15(seven with Mason type Ⅲ and eight with Mason type Ⅳ)received open reduction and internal fixation including nail and plate fixation in eight and screw and K-wire fixation in seven.The outcomes were assessed in regard of range of motion,radiographic findings,visual analogous scale(VAS)of pain,patient satisfaction degree,disabilities of the arm,shoulder and hand score system(DASH)and the Broberg & Morrey elbow performance score system.Results The follow-up period ranged from 12 to 65 months(mean 35 months),which showed fracture healing in all patients,with no traumatic arthritis happened.The mean range of flexion and extension arc at the elbow of ORIF group and resection group was 132°and 79.4°(P＜0.01)and the patient satisfaction was 9.1 and 8.0(P ＜0.05)respectively.According to the Broberg & Money elbow performance score system,the score was average 93.9 in the ORIF group,with excellent result in nine patients,good in five and fair in one,while the score was average 80.6 in the resection group,with excellent result in two patients,good in two and fair in four.There was statistical difference between two groups(P ＜0.01).The DASH score of the ORIF and resection group was 2.9 and 18.1 respectively(P＜0.05).Conclusions ORIF has better elbow motion,elbow function,daily living and satisfactory outcomes than radial head resection and is recommended for treatment of Mason type Ⅲ or Ⅳ radial head fractures for repair of the radial head as far as possible. Key words: Radius fractures; Fracture fixation, internal; Resection of conninuted radial head