Abstract
BackgroundAn inadequate clinical outcome after conservatively treated radial head fractures is not uncommon. We analyzed the subjective limitations, objective complaints, and surgical procedures for radial head fractures initially treated conservatively.Patients and methodBetween 2007 and 2016, 70 patients (42 men, 28 women) who suffered from fracture sequelae after conservatively treated radial head fractures were examined. Demographic (age, 41.8 years, range, 16–75 years) and clinical data (pain, range of motion, instability) were retrospectively evaluated.ResultsThe average time to surgery after trauma was 50 months (range, 5–360 months). In 38 cases, radial head fractures were initially treated with immobilization for 3.4 weeks (range, 1–8 weeks). Physiotherapeutic treatment was performed in 39 cases. In only half of the cases was retrospective Mason classification possible: 20 type I, 8 type II, 5 type III, and 2 type IV. Of the 70 patients, 53 had posttraumatic elbow stiffness; 34 had isolated lateral and four patients isolated medial ligament instability. There were eight cases with a combination of lateral and medial ligament instability and 27 cases of elbow stiffness combined with instability. An average of 1.2 (range, 1–4) surgical procedures per patient were performed. In all, 64 patients underwent elbow arthroscopy with arthrolysis and additional treatment depending on other injuries. The range of motion improved on average from preoperative flexion/extension of 131–15–0° to postoperative flexion/extension of 135–5–0° (gain in flexion: 4.2° and extension: 10.6°).ConclusionConservative treatment of radial head fractures does not always yield good results. Reasons for a poor outcome include chronic instability, cartilage damage, stiffness, or a combination thereof. Improved outcomes can be achieved via arthroscopic arthrolysis.
Highlights
Patients and methodsThis retrospective, descriptive, and explorative observational study included patients who underwent surgery for fracture sequelae after conservatively treated radial head fractures
An inadequate clinical outcome after conservatively treated radial head fractures is not uncommon
Radial head fractures tend to be underestimated by clinicians, in particular because of the lack of evidence of displacement on plain radiographs and the good results achieved with conservative treatment
Summary
This retrospective, descriptive, and explorative observational study included patients who underwent surgery for fracture sequelae after conservatively treated radial head fractures. The duration of conservative therapy was 50 months (range, 5–360 months) from the time of trauma to surgery. Medical files were analyzed according to the fracture sequelae, range of motion, stability, and patient complaints. After joint insufflation through the soft spot portal with 20 ml of normal saline solution, an inflow cannula was placed for the continuous supply of arthroscopy fluid via the anteroradial. The entire dorsal elbow joint section was inspected with the camera via the high dorsoradial portal and, if necessary, treated using the trans-tricipital portal. In 35 cases (50.0%), retrospective grading according to the Mason classification could not be made because radiological images at the time of the trauma were absent and there was incomplete or missing data on the initial classification.
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