Abstract
BackgroundThe treatment of comminuted unsalvageable radial head fracture remains controversial. Open reduction and internal fixation with metallic plates and screws are hard to achieve. Conventional techniques include radial head resection and arthroplasty. Both methods have inevitable complications. The purpose of this retrospective study is to prove the feasibility of treating unsalvageable radial head fractures with absorbable polylactide pins. MethodsA total of 17 patients with severely comminuted Mason type III radial head fractures were treated with open reduction and internal fixation using polylactide pins and 23 with metallic plates and screws. Patients receiving both modalities were followed-up for a mean of 24 months (standard deviation SD: 2.6). Radiographic analysis was conducted 2, 30, 60, and 120 days after surgery. Measurements of range of motion (ROM), disability of arm shoulder and hands, Mayo elbow performance score, and Broberg and Morrey elbow score were recorded, with treatments compared using a Mann-Whitney U test. ResultBy the time of last follow up, All fractures in both groups healed successfully. The duration (134 min SD:21 min to 131 min SD:19 min) and blood loss (121 ml SD: 25 ml to 124 ml SD: 27 ml) during surgery of polylactide pin and metallic implant group have no statistical differences. The MEPI score (91 SD:7 to 94 SD:9), the Broberg and Morrey score (93 SD:3 to 93 SD:5), the DASH outcome measures (4.5 SD: 3.0 to 3.7 SD: 3.5), the range of motion also shows no statistical differences. Complications were infrequent and did not cause disability in both groups. All patients were satisfied with the surgical outcomes. ConclusionPolylactide pins can feasibly treat severely comminuted radial head fractures, which usually are considered unreducible. This technique provides an optional treatment plan in addition to resection or arthroplasty, especially for young patients that refuse that form of treatment.
Highlights
The present study aims to demonstrate the feasibility of treating unreducible radial head fractures with absorbable polylactide pins
A total of 17 patients with severely comminuted Mason type III radial head fractures were treated with open reduction and internal fixation using polylactide pins and 23 with metallic implants
Mason type III-IV radial head fractures in which the head is severely comminuted are considered unsalvageable and difficult to treat with open reduction and internal fixation (ORIF)(1)
Summary
Mason type III-IV radial head fractures in which the head is severely comminuted are considered unsalvageable and difficult to treat with open reduction and internal fixation (ORIF)(1). Such fractures have been previously treated with radial head resection with good results having been reported [2]. Long-term studies have demonstrated that radial head resection leads to a series of complications such as proximal migration of the radius, valgus instability and distal radioulnar joint (DRUJ) dysfunction[3, 4]. The treatment of comminuted unsalvageable radial head fracture remains controversial. Common techniques include radial head resection and arthroplasty The present study aims to demonstrate the feasibility of treating unreducible radial head fractures with absorbable polylactide pins
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