Current concepts in the treatment of radial head fractures in the adult. A clinical and biomechanical approach.
The treatment of simple radial head fractures type Mason-Hotchkiss 1 and 2 is unequivocal. In the case of a displacement of less than 2 mm (Mason-Hotchkiss 1), functional conservative treatment is indicated. If the displacement is more than 2 mm (Mason-Hotchkiss 2) internal fixation is indicated, combined with treatment of the soft-tissue injuries. The treatment of comminuted radial head fractures Mason-Hotchkiss type 3 is more controversial, as they are usually associated with ligament injuries. Conservative treatment appears to have unsatisfactory results. Opinions differ on surgical treatment, i.e. 1) excision of the radial head; 2) reconstruction by means of internal fixation; 3) excision and reconstruction with a prosthesis. Basic experimental research on human cadaver elbows shows the importance of the conservation of the radial head, especially in case of associated soft tissue injuries. In most cases a stable osteosynthesis is impossible, and in case of associated ligament disruptions, resection and reconstruction by means of a rigid radial head prosthesis should be considered. Experimental research demonstrates promising results for rigid radial head prostheses in human cadaver elbows with a resected radial head and failing medical collateral ligament. Short-term clinical studies seem to confirm this, but long-term results are as yet unknown.
Van Glabbeek
F
F
Department of Orthopedic Surgery and Trauma, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. Francis.Van.Glabbeek@uza.be
Van Riet
R
R
Verstreken
J
J
D001696:Biomechanical Phenomena; D002102:Cadaver; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007103:Immobilization; D011885:Radius Fractures / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index