Open reduction and internal fixation compared with excision for unstable displaced fractures of the radial head.
OBJECTIVE
To determine if excision of the radial head for treatment of an unstable, displaced fracture is associated with a higher rate of early complications or late arthrosis as compared with open reduction and internal fixation (ORIF).


METHODS
Unstable, displaced fractures of the radial head treated with either excision (15 patients) or ORIF (13 patients) were compared. Implants were removed routinely during the study period. Three patients had instability after radial head excision: 2 were treated in a cast and 1 had temporary pinning of the ulnohumeral joint. Two patients in the ORIF cohort had failure of fixation that subsequently was treated with radial head excision: 1 had early hardware loosening and 1 developed a nonunion.


RESULTS
At the 1-year follow-up evaluation there were no significant differences in the flexion or rotation arc. An average of 17 years after injury there was no significant difference in the flexion arc or rotation arc. One result was rated as unsatisfactory in each cohort according to the Mayo Elbow Performing Index. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 5 points in the ORIF cohort and 15 points in the excision cohort. Eight patients in the excision cohort had arthrosis (5 mild, 2 moderate, 1 severe) compared with 2 patients in the ORIF cohort (1 mild, 1 moderate).


CONCLUSIONS
Open reduction and internal fixation of an unstable, displaced fracture of the radial head occasionally fails, but it seems to reduce the risk of subsequent elbow dislocation and to protect against long-term arthrosis.


METHODS
Therapeutic III.
Lindenhovius
Anneluuk L C
AL
Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
Felsch
Quinten
Q
Doornberg
Job N
JN
Ring
David
D
Kloen
Peter
P
D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011859:Radiography; D011884:Radius / Q000601:surgery*; D011885:Radius Fractures / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function