Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures - A Prospective Cohort Study.

Abstract

To identify patient-related factors and fracture characteristics influencing the functional outcomes of non-operatively treated radial head fractures and to determine function at one year. Prospective cohort study. Academic level 1 trauma center. Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016. Nonoperative treatment of isolated radial head fractures. Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) score and Range of Motion (ROM) at 1.5-3-6-12 months. 114 patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3] and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with respectively 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups (p <0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1-year (p <0.05). While most non-operatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1-year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow interventions that may optimize function.