Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study.
BACKGROUND
The purpose of this study was to evaluate the incidence and the long-term results of closed uncomplicated Mason type-II and III fractures in a defined population of adults.


METHODS
Seventy women and thirty men who were a mean of forty-seven years old when they sustained a fracture of the radial head or neck (a Mason type-II fracture in seventy-six patients and a Mason type-III fracture in twenty-four) were reexamined after a mean of nineteen years. Radiographic signs of degenerative changes of the elbow were recorded. The fracture had been treated with an elastic bandage or a collar and cuff sling with mobilization for forty-four individuals, with cast immobilization for thirty-four, with resection of the radial head in nineteen, with open reduction of the radial head in two, and with a collateral ligament repair in one. Secondary excision of the radial head was performed because of residual pain in nine patients, and a neurolysis of the ulnar nerve was performed in one patient.


RESULTS
Seventy-seven individuals had no symptoms in the injured elbow at the time of follow-up, twenty-one had occasional pain, and two had daily pain. The injured elbows had a slight flexion deficit compared with the uninjured elbows (mean and standard deviation, 138 degrees +/- 8 degrees compared with 140 degrees +/- 7 degrees ) as well as a small extension deficit (mean and standard deviation, -4 degrees +/- 8 degrees compared with -1 degrees +/- 6 degrees ) (p < 0.001 for both). The prevalence of degenerative changes was higher in the injured elbows than in the uninjured ones (76% compared with 16%, p < 0.001).


CONCLUSIONS
The results following uncomplicated Mason type-II and III fractures are predominantly favorable. A secondary radial head resection is usually effective for patients with an unfavorable outcome (predominantly long-standing pain).


METHODS
Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
Herbertsson
Pär
P
Department of Orthopaedics, University Hospital MAS, SE-205 02 Malmo, Sweden. par.herbertsson@skane.se.
Josefsson
Per-Olof
PO
Hasserius
Ralph
R
Karlsson
Caroline
C
Besjakov
Jack
J
Karlsson
Magnus
M
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001915:Braces / Q000009:adverse effects; D002370:Casts, Surgical / Q000009:adverse effects; D004551:Elbow Joint; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D005596:Fractures, Closed / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D018737:Hand Strength; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D011403:Pronation; D011859:Radiography; D011885:Radius Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013484:Supination; D016896:Treatment Outcome