Radial head arthroplasty provides successful long-term results in patients treated for comminuted fractures of the radial head, minimum eight-year follow-up

Background: Radial head arthroplasty is an alternative treatment for complex radial head fractures that are not appropriate for fixation. No study to date has reported the outcomes of monoblock ultrahigh molecular weight polyethylene (UHMW-PE) radial head prosthesis (RHP) for the treatment of radial head fracture. We aimed to evaluate the functional and radiographic outcomes of patients with unreconstructable acute radial head fractures treated with a monoblock UHMW-PE RHP. Methods: Patients who underwent UHMW-PE RHP placement for the treatment of radial head fracture were included in this retrospective case series. Patients who did not complete follow-up were excluded. Primary outcome measurements were the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder, and Hand (DASH) score. The latest follow-up physical examination and radiographs were evaluated for loosening, subluxation, and dislocation. Postoperative complications and need for further surgery were noted. Results: Eleven patients (four female and seven male patients) with a mean follow-up of 18.5 mo were evaluated. The mean MEPS was 79.5 (range, 65–100) at 3 mo postoperatively and 85.9 (range, 75–100) at the latest follow-up. The mean DASH score was 10.8 (range, 3–20) at 3 mo postoperatively and 8.7 (0–20) at the latest follow-up. No complications were encountered during follow-up. Conclusions: Radial head arthroplasty with a monoblock UHMW-PE RHP is safe and effective at short-term follow-up for treating acute unreconstructable radial head fractures with satisfactory functional and radiographic outcomes. Level of Evidence: Level IV.

<p class="abstract"><strong>Background:</strong> Radial head fractures are about 20% of all the elbow fractures. Comminuted radial head fractures can cause great impairment on upper extremity functional status. In older times, radial head resection was the treatment of choice for comminuted radial head fractures. Recently, radial head implant arthroplasty has become popular for fractures that could not be fixed. In this study, we assess the clinical outcomes in patients who underwent Radial head resection in Indian population of the productive age group.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 15 patients of age more than 18 and less than 50 years of age, who have underwent radial head resection for Mason type III radial head fractures. Outcomes were evaluated according to the Mayo Elbow Performance Score at 3 months, 6 months and at 1 year follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed that 80% of our patients were pain free at the end of 1 year and 20% had minimal to moderate pain. About 80% of our patients regained their “functional range” of movements. 12 of our patients had a stable elbow joint and only 3 patients complained of minimal to moderate instability after the procedure. 87% of our patients had a good to excellent functional outcome at the end. The mean Mayo elbow performance score was 92.3 which is graded as excellent and did not have any significant complications to hinder the clinical outcome.</p><p class="abstract"><strong>Conclusions:</strong> Radial head resection yields a good to excellent clinical results in young Indian population with isolated comminuted radial head fractures.</p>

ABSTRACTPurpose: To compare clinical outcomes of unipolar and bipolar radial head prosthesis in the treatment of patients with radial head fracture. Materials and Methods: Medline, Cochrane, EMBASE, Google Scholar databases were searched until April 18, 2016 using the following search terms: radial head fracture, elbow fracture, radial head arthroplasty, implants, prosthesis, unipolar, bipolar, cemented, and press-fit. Randomized controlled trials, retrospective, and cohort studies were included. Results: The Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, radiologic assessment, ROM, and grip strength following elbow replacement were similar between prosthetic devices. The pooled mean excellent/good ranking of MEPS was 0.78 for unipolar and 0.73 for bipolar radial head arthroplasty, and the pooled mean MEPS was 86.9 and 79.9, respectively. DASH scores for unipolar and bipolar prosthesis were 19.0 and 16.3, respectively. Range of motion outcomes were similar between groups, with both groups have comparable risk of flexion arc, flexion, extension deficit, rotation arc, pronation, and supination (p values <0.001 for both unipolar and bipolar prosthesis). However, bipolar radial head prosthesis was associated with an increased chance of heterotopic ossification and lucency (p values ≤0.049) while unipolar prosthesis was not (p values ≥0.088). Both groups had risk for development of capitellar osteopenia or erosion/wear (p values ≤0.039). Conclusion: Unipolar and bipolar radial head prostheses were similar with respect to clinical outcomes. Additional comparative studies are necessary to further compare different radial head prostheses used to treat radial head fracture.

Introduction: Radial head fractures (RHF) constitute 33% of all elbow fractures. The Mason classification system, introduced in 1954 and modified in 1962, remains pivotal for prognostic and preoperative planning. Comminuted radial fractures (modified Mason type III and IV) provide difficult and contentious treatment issues. Numerous studies have been conducted on surgical procedures like radial head arthroplasty (RHA) and open reduction and internal fixation (ORIF). Previous meta-analyses suggest RHA may offer slightly superior elbow function and fewer unfavorable occurrences in the short term compared to ORIF for Mason type III RHF although the evidence quality is low. This study systematically reviews and compares the outcomes of ORIF versus RHA using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM) evaluations. Method: PRISMA guidelines were used in conducting the systematic review. We searched Cochrane Library, PubMed, and Google Scholar for comprehensive, peer-reviewed English studies. that compared the results of ORIF plate screw and RHA in RHF. The inclusion criteria were studies comparing clinical outcomes of these operative treatments, with outcomes assessed including DASH score, quick DASH score, MEPS, and ROM. AHRQ, GRADE Working Group, and Oxford Center for Evidence-based Medicine criteria were used to evaluate the study's quality and bias risk. Results: The initial search yielded 158 studies. After excluding duplicates and screening titles and abstracts, five studies met the inclusion criteria. All included studies were randomized controlled trials. The mean age of participants was over 35 years, with more males than females. The sample sizes varied, with most studies including over 30 patients. Subgroup analyses revealed significant differences between ORIF and RHA groups. In terms of the Mayo Elbow Performance Score (MEPS), plating was found to be more favorable, with a mean difference of 4.05 (95% CI, 0.11 to 8.00). For flexion range of motion (ROM), arthroplasty was superior, showing a mean difference of -1.88 (95% CI, -2.53 to -1.24). Pronation ROM favored plating with a mean difference of 2.63 (95% CI, 2.09 to 3.18), and supination ROM also favored plating, with a mean difference of 8.22 (95% CI, 7.50 to 8.95). Conclusion: Based on the included studies, both ORIF and RHA are viable surgical options for RHF Mason type II and III fractures. Plating was more favorable for MEPS and supination/pronation ROM, while RHA was better for flexion ROM. More extensive studies are required to draw definitive conclusions and guide treatment strategies for RHF. Keywords: Arthroplasty, ORIF, Radial head fracture

To compare the outcome following headless compression screw fixation versus radial head arthroplasty versus plate fixation for 3-part Mason types III or IV radial head fracture. Records of 25 men and 16 women aged 21 to 80 (mean, 43.3) years who underwent fixation using 2 to 3 2-mm cannulated headless compression screws (n=16), radial head arthroplasty (n=13), or fixation with a 2-mm Synthes plate (n=12) for 3-part Mason types III or IV radial head and neck fracture were reviewed. Treatment option was decided by the surgeon based on the presence of associated injury, neurovascular deficit, and the Mason classification. Bone union, callus formation, and complications (such as heterotopic ossification, malunion, and nonunion) were assessed by an independent registrar or consultant using radiographs. The Mayo Elbow Performance Score and range of motion were assessed by an independent physiotherapist. The median age of the 3 groups were comparable. Associated injuries were most common in patients with arthroplasty, followed by screw fixation and plate fixation (61.5% vs. 50% vs. 33%, p=0.54). The median time to bone union was shorter after screw fixation than plate fixation (55 vs. 86 days, p=0.05). No patient with screw fixation had nonunion, but 4 patients with plate fixation had nonunion. The 3 groups were comparable in terms of the mean Mayo Elbow Performance Score (p=0.56) and the mean range of motion (p=0.45). The complication rate was highest after plate fixation, followed by screw fixation and arthroplasty (50% vs. 18.8% vs. 15.4%, p=0.048). Excluding 20 patients with associated injuries (8 in screw fixation, 8 in arthroplasty, and 4 in plate fixation), the 3 groups were comparable in terms of the median time to bone union (p=0.109), mean Mayo Elbow Performance Score (p=0.260), mean range of motion (p=0.162), and complication rate (p=0.096). Headless compression screw fixation is a viable option for 3-part radial head fracture. It achieves earlier bone union with fewer complications.

The comparative performance of radial head prostheses in patients younger than and older than 50 years: a systematic review

What happens to the elbow 15 years after a radial head prosthesis? A clinical and imaging long-term follow-up study.

The “Terrible Triad” of the Elbow

Open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) are the most common operative treatments in patients with radial head fractures. The purpose of this study was to determine the efficacy of RHA and ORIF treatments in patients with radial head fractures (modified Mason type III and IV). We conducted a computerized search of five electronic databases from their inception to July 2015. All clinical trials comparing ORIF versus RHA treatment in patients with radial head fractures were included. We evaluated the primary outcomes included elbow functional evaluation criteria by Broberg and Morrey, elbow score (Broberg and Morrey), Mayo Elbow Performance Score (MEPS) and QuickDASH score. Secondary outcomes included Visual Analog Scale (VAS), range of motion, operation time and complications. The "assessing risk of bias" table was applied to assess the risk of bias of the included studies. Eight studies were included in this meta-analysis, which consisted of 138 cases of ORIF and 181 RHA. Methodological quality of the studies was moderate to low. RHA afforded significantly higher satisfaction rate, better elbow score (Broberg and Morrey) and MEPS, shorter operation time, lower incidence of bone nonunion or absorption and internal fixation failure when compared to ORIF. There were no significantly differences in QuickDASH score and other complications. RHA has better outcome in patients with radial head fractures (modified Mason type III and IV) than ORIF with medium-short-term follow-up period, but longer-term studies will be required to ascertain whether the apparent benefits of RHA were offset by late complications. Therapeutic decision analysis; a meta-analysis, Level III.

Radial head fractures constitute approximately one-third of all elbow fractures, significantly impacting the young and active population. While open reduction and internal fixation is the preferred treatment for displaced fractures, its high complication rate in comminuted fractures has led to the increasing use of radial head arthroplasty (RHA). RHA provides improved functional outcomes with fewer complications, yet its long-term efficacy remains a topic of debate. To evaluate the functional outcomes of patients undergoing RHA with a modular metallic prosthesis for comminuted Mason type III and IV radial head fractures. A prospective and retrospective hospital-based study was conducted at Dayanand Medical College and Hospital, Ludhiana over 32 months (January 2021-August 2023). A total of 26 patients with Mason type III and IV fractures were included, with six retrospective and 20 prospective cases. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), elbow range of motion, pain via Visual Analog Scale, and activities of daily living at immediate postoperative, three-month, and six-month follow-ups. MEPS at 6 months follow up for 4 cases (15.38%) had good scores, and 22 cases (84.62%) had excellent scores, with a mean ± SD of 97.31 ± 6.67. Comparisons showed significant improvement from immediate post-operative to 3 months (P < 0.0001), from immediate post-operative to 6 months (P < 0.0001), and between 3 months and 6 months (P < 0.0001). None of the patients had elbow instability after radial head replacement and 22 cases (84.62%) had no complications, while 3 cases (11.54%) had a stiff elbow, and 1 case (3.85%) had heterotopic ossification. RHA is an effective treatment for comminuted radial head fractures, providing stable elbow function with minimal complications.

Outcomes of press-fit radial head arthroplasty following complex radial head fractures

Background: The ‘terrible triad’ of the elbow—posterior dislocation, radial head fracture and coronoid process fracture—severely destabilises the joint. The debate centres on whether radial head replacement or anatomical reconstruction best restores function. Objective: To compare short-term functional recovery, complication rates and patient satisfaction between radial head arthroplasty and reconstruction in terrible triad elbow injuries (TTIE) within a North Indian cohort. Materials and Methods: A prospective, randomised study (January 2023–March 2025) enrolled 55 TTIE patients, divided into Group A (reconstruction, n = 27) and Group B (prosthesis, n = 28). Following four and five follow-up losses, respectively, 46 patients (23 per group) were analysed at 6 months. Interventions included coronoid fixation and lateral ulnar collateral ligament repair for all. Primary outcomes are as follows: Range of motion (ROM), Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes are as follows: complications and patient-reported pain (visual analogue scale [VAS]) and satisfaction. Results: Group B showed significantly better mean ROM (120.8° ± 14.0 vs. 113.5° ± 16.5; P = 0.0011), MEPS (92.3 ± 5.0 vs. 87.7 ± 4.7; P = 0.0009) and lower DASH (14.0 ± 2.6 vs. 16.5 ± 3.2; P = 0.0021). Pain scores were lower (VAS 2.1 vs. 3.7) and satisfaction higher in Group B. Complications were fewer in Group B: stiffness (22% vs. 35%), arthrosis (9% vs. 26%), loosenings (4% vs. 9%) and revisions (4% vs. 13%). Conclusions: Radial head prosthesis yields superior early functional outcomes, less pain, higher patient satisfaction and fewer complications compared to anatomical reconstruction in TTIE, especially for comminuted fractures. Reconstruction remains a viable option in select cases. These are short-term results; longer-term multicentre studies are required to evaluate implant survival, cost-effectiveness and late complications.

Radial head and neck fractures represent a significant portion of elbow fractures in adults, particularly affecting younger patients due to falls onto outstretched hands. Surgical treatment is often necessary for displaced and comminuted fractures, especially those with associated ligamentous injuries. This study evaluates the long-term clinical, functional, and radiological outcomes of patients with Mason type III and IV radial head fractures managed through open reduction and internal fixation using plate and screw osteosynthesis, due to the unavailability of radial head prostheses. We retrospectively analyzed 28 patients with Mason typeIII or IV radial head fractures treated with open reduction and internal fixation (ORIF) between 2020 and 2024. Clinical assessments included the visual analog scale (VAS) for pain, Mayo Elbow Performance (MEP) Score, and Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) score, as well as measurements of elbow flexion, extension, supination, and pronation. Radiographic evaluations assessed fracture union, loss of reduction, implant breakage or loosening, avascular necrosis, radiographic arthritis, and heterotopic ossification. At a mean follow-up of 29.1 ± 20.1 months in 28 patients (16M/12F; mean age48.5 ± 12.6years), mean elbow flexion was 120.4 ± 14.7, extension loss 10 ± 5.9, supination 68.9 ± 8.8°, and pronation 62.8 ± 7.1°, with mean VAS2.3 ± 1.1, MEP Score83.0 ± 8.9, and Quick-DASH12.8 ± 7.6. Complete fracture union was achieved in 25 cases, partial union in 2, and asymptomatic nonunion in 1. Complications occurred in three patients (10%), including implant loosening, loss of reduction, heterotopic ossification, and avascular necrosis; two patients showed post-traumatic degenerative changes. One patient required K-wire removal due to migration and another underwent revision fixation with iliac crest bone graft for screw loosening/nonunion. No cases needed open arthrolysis or secondary radial head resection. While osteosynthesis is effective in managing Mason type III and IV radial head fractures, having a radial head prosthesis available in the operating room can provide flexibility, especially in comminuted fractures, and potentially reduce the need for revision surgeries. These findings underscore the importance of adaptable surgical planning to improve outcomes in complex radial head fractures.

BackgroundThe use of bone graft for the radial head fractures has been previously described and occasionally used by other authors.This is the first paper, to my knowledge, dealing with the relevant issue about the importance that the use of an autologous bone graft can have on the radial head fractures.MethodsFrom July 2010 to July 2014, 20 consecutive patients who underwent open reduction and internal fixation for a closed Mason type II radial head fracture were retrospectively reviewed. Patients with Mason type I, III, simple type II, and comminuted type II fractures treated without bone grafting were excluded. A clinical examination and radiographic evaluation were performed. The overall functional result was evaluated using the Mayo Elbow Performance Score (MEPS). The Broberg and Morrey classification was used to evaluate traumatic arthritis.ResultsThe average follow-up duration was 31 months (range, 24–50 months). Bone union of the radial head fracture was achieved in all patients at an average of 13.5 weeks (range, 12–17 weeks). Postoperative radiographs showed no cases of postsurgical ligamentous instability, necrosis of the radial head, or internal fixation failure. The mean range of motion of the affected elbow was 128° ± 8.4° in flexion, 14.5° ± 11.1° in extension, 68.7° ± 14.1° in pronation, and 65.2° ± 18.2° in supination. The mean MEPS was 92 ± 7.9 points (range, 80–100); the outcome was excellent (90–100 points) in 13 patients and good (75–89 points) in 7 patients. The MEPS tended to be higher in patients with an isolated fracture (p = 0.016). Based on the Broberg and Morrey classification for radiographic assessment of post-traumatic arthritis, 15 elbows had no evidence of degenerative changes (grade 0), and 5 elbows had grade 1 changes.ConclusionAlthough radial head fractures may not be amenable to internal fixation, our findings suggest that open reduction and internal fixation with an autogenous bone graft from the lateral epicondyle of the humerus provides satisfactory elbow function in patients with comminuted Mason type II radial head fractures.

Résultats de l’arthroplastie de la tête radiale implantée en press-fit après fracture complexe de la tête radiale