title: A retrospective cohort study of displaced segmental radial head fractures: is 2 mm of articular displacement an indication for surgery?
abstract: OBJECTIVE
  Many investigators agree that 2 mm of articular displacement is a reasonable indication for open reduction and internal fixation of Mason type II fractures of the radial head. However, there is no evidence to support that this degree of articular displacement is predictive of poor outcomes in conservatively treated fractures. We hypothesized there would be no difference between conservatively treated radial head fractures with greater 2 mm of displacement and those with less than 2 mm of displacement in terms of patient-reported or clinical outcomes.
  
  
  METHODS
  We reviewed databases of all radial head fractures in our region. The primary outcomes were the Patient-Rated Elbow Evaluation and Disabilities of the Arm, Shoulder and Hand questionnaires. Secondary outcomes included radiologic radiocapitellar arthritis and range of motion (ROM) at follow-up. Postinjury treatment protocols, as well as patient factors, were examined for their effects on outcome.
  
  
  RESULTS
  The results showed no significant difference in any outcome for conservatively treated radial head fractures with 2 mm (P = .8) or even 3 mm (P = .6) of articular displacement over a mean follow-up of 4.4 years. Early ROM and physiotherapy showed no significant differences in any outcome measure. Dominant hand injury showed no significant difference in patient-reported outcomes; however, ROM was significantly decreased on examination.
  
  
  CONCLUSIONS
  This retrospective review suggests that fracture displacement of 2 to 3 mm is not necessarily an indication for surgical fixation in isolated fractures of the radial head. In addition, it appears that postinjury ROM/physiotherapy does not play a large role in improving patient outcome.
authors.affiliation: Section of Orthopaedic Surgery, Faculty of Medicine, University of Calgary, Alberta, Canada. mjfurey@ucalgary.ca
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Furey
authors.forename: David M
authors.initials: DM
authors.lastname: Sheps
authors.forename: Neil J
authors.initials: NJ
authors.lastname: White
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hildebrand
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries