Open Reduction and Internal Fixation in Comminuted Radial Head Fracture

Financial support: None. Conflict of interests: None. Purpose: Radial head fractures, which account for 33% of all fractures, are treated depending on the Mason classification. In comminuted type 3 fractures, open reduction internal fixation (ORIF), and radial head arthroplasty are the treatment options. This study examined the clinical outcome of modified Mason type 3 radial head fractures using ORIF with a plate. Materials and Methods: The medical records and image of 33 patients, who underwent ORIF for modified Mason type 3 radial head fractures, were reviewed retrospectively. The preoperative plain radiographs and computed tomography images were used to examine the location of the fracture of the radial head, the number of fragments, union, joint alignment, and traumatic arthritis at the final followup. The range of motion (ROM) of the elbow at the last follow-up, pain score (visual analogue scale), modified Mayo elbow score (MMES), and complications were analyzed for the clinical outcome. Results: Of the 33 cases, 14 were men and 19 were women. The mean age was 41.8 years and the average follow-up period was 19 months. The functional ROM was divided into three groups according to the number of bone fragments: 141.2°±9.3° of 3 (n=20), 123.8°±18.5° of 4 (n=7), 100.7°±24.4° of more than 4 (n=6). Furthermore, the MMES were 88.2±2.9, 83.7±4.3, and 77.3±8.4, respectively (p=0.027). Depending on the radial head fracture location, the ROM and MMES were 130.7°±7.5° and 82.1±4.7, respectively, with poor outcomes on the ulnar aspect compared to 143.1°±3.8° and 89.9±3.2 on the radial aspect. Conclusion: Various factors, such as the degree of crushing and location involved in the clinical outcome. In particular, the result was poor in the case of more than four comminuted fragments or chief position located in the ulnar aspect. In this case, radial head arthroplasty may be considered in the early stages.