Conservative treatment for Mason II and III type of radial head fractures without bony block

Abstract

Objective To discuss the efficacy of conservative treatment for Mason II and III type of radial head fracture without bony block. Methods From January 2009 to March 2016, 42 patients with type II and type III radial head fractures but no bony block were included, and there were 20 males and 22 females, 18 cases on the left side and 24 cases on the right side. The average age was 32.32±13.62 (range, 15-51) years old. Mason type II were in 33 cases, while type III 9 cases. All were treated by short-time immobilization combined with early functional exercise. When taking exercise, oral analgesics were used to relieve pain to less than 3 points of visual analogue scale (VAS) which allowing active activities combined with gentle passive activities to reach full range of motion. Results The average follow-up time was 35.13±8.56 (range, 4-82) months. 37 patients had a normal function 2 months after injury, while 5 cases had extension limitation at final follow-up, but less than 30°, without flexion and rotation restriction, no influence on daily life and work. Mean flexion was 136.26°±5.43° (range,130°-140°); mean extension was 3.36°±14.13° (range, 30°-overextension 10°); average flexion and extension ROM was 133.25°±16.43° (range, 100°-150°); average pronation was 87.67°±6.32° (range, 80°-90°); mean supination was 90°; average rotation range of motion 177.63°±5.39° (range, 170°-180°); Mayo elbow performance score (MEPS) was 100 points, and the excellent and good rate 100%. No obvious symptoms of pain were found. There were no nonunion, avascular necrosis and joint degeneration. Conclusion By pain relief and strict examination of patients with Mason II and IIIype of radial head fracture to determine whether there is bony block, if there is, the patients have to be treated surgically, if there is no bony block and separation displacement, even severe comminuted radial head fractures can be treated conservatively. By short-time immobilization and reasonable rehabilitation, the elbow function can be restored to normal or near normal, with no nonunion, avascular necrosis, joint degeneration and other complications. Key words: Elbow joint; Radius fractures; Exercise movement techniques; Treatment outcome