title: Mason type II and III radial head fracture in patients older than 65: is there still a place for radial head resection?
abstract: OBJECTIVE
  To evaluate the clinical outcomes of radial head excision for multifragmentary radial head fracture in patients over 65 years old.
  
  
  METHODS
  We retrospectively examined 30 patients over 65 years of age treated with radial head excision for comminuted radial head fractures. Patients were evaluated through clinical examinations, administrative questionnaires (DASH--Disabilities of the Arm, Shoulder and Hand; MEPS--Mayo Elbow Performance Score, VAS--Visual Analog Scale) and plain films.
  
  
  RESULTS
  The mean follow-up was 40 months (range 24-72 months); 27 out of 30 patients claimed to be satisfied. The mean DASH score was 13 (range 3-45.8) and mean MEPS was 79 (range 65-97). The radiographic evaluation showed 21 cases of elbow arthritis; only two of them complained about pain. Heterotopic ossification was evident in six cases with functional impairment in only one patient. Six patients with increased ulnar variance had clinical distal radio-ulnar joint instability.
  
  
  CONCLUSIONS
  Radial head excision has been considered a safe surgical procedure with satisfactory clinical outcomes. Development in biomechanical studies and prosthetic replacement of the radial head question the validity of radial head excision. In current literature, there are neither long-term follow-up studies on radial head prosthesis outcomes nor studies which consider elderly patient samples.
  
  
  CONCLUSIONS
  Radial head resection remains a good option when a radial head fracture occurs in elderly patients, taking into account the influence of poor bone quality and comorbidities on the outcome. Radial head excision is not indicated in the presence of associated lesions, because of the risk of residual elbow instability; complications associated with advanced age must be considered and a strict follow-up granted.
authors.affiliation: Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Solarino
authors.affiliation: Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy. dott.gvicenti@gmail.com.
authors.forename: Giovanni
authors.identifier: http://orcid.org/0000-0002-7412-7990
authors.initials: G
authors.lastname: Vicenti
authors.affiliation: Orthopaedic and Trauma Department, University of Foggia, Foggia, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Abate
authors.affiliation: Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Carrozzo
authors.affiliation: Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Picca
authors.affiliation: Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari "Aldo Moro", Bari, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Moretti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018460:Fractures, Comminuted / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D011859:Radiography; D011884:Radius / Q000473:pathology / Q000601:surgery; D011885:Radius Fractures / Q000175:diagnosis / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Elbow; Functional elbow range of motion; Mason’s classification; Radial head excision; Radial head fracture