title: Radial head fractures: loss of cortical contact is associated with concomitant fracture or dislocation.
abstract: OBJECTIVE
  Among radial head fractures displaced greater than 2 mm (Broberg and Morrey modified Mason type 2), separation (complete loss of cortical contact) of at least 1 radial head fracture fragment is associated with a complex injury pattern, meaning that there are other concomitant elbow fractures or ligament injuries.
  
  
  METHODS
  We identified 291 consecutive skeletally mature patients with 296 radial head fractures treated during a 6-year period. Of these, 121 consecutive fractures of part of the radial head displaced greater than 2 mm (type 2) were classified according to whether there was complete lack of cortical contact between a fracture fragment and the rest of the proximal radius. Predictors of isolated vs complex injury pattern were sought in bivariate and multivariable analyses.
  
  
  RESULTS
  Of 121 fractures, 30 (25%) were classified as having cortical contact, and 91 (75%) were classified as not having cortical contact. Ten (33%) with cortical contact were part of a complex elbow injury, and 83 of 91 fractures (91%) without cortical contact were part of a complex elbow injury (P < .01). Among the Mason type 2 fractures, loss of cortical contact was a significant predictor of a complex elbow injury in both bivariate and multivariable analyses, with an odds ratio of 21 (95% confidence interval, 7-59).
  
  
  CONCLUSIONS
  Among Mason type 2 fractures, complete loss of cortical contact of at least one fracture fragment is strongly predictive of a complex injury pattern.
  
  
  METHODS
  4, Retrospective case series, Treatment study.
authors.affiliation: Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Rineer
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Guitton
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D017677:Age Distribution; D016001:Confidence Intervals; D016208:Databases, Factual; D004551:Elbow Joint / Q000473:pathology / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D055815:Young Adult; D000092464:Elbow Injuries