Good outcomes of bipolar radial head arthroplasty for comminuted radial head fractures : a cohort study of 64 patients with an average 5.2-year follow-up.

Aims: Radial head fractures are among the most common upper limb fractures, constituting up to 30% of all elbow fractures. While many can be managed non-surgically with favourable outcomes, approximately one-third require surgical intervention, typically involving open reduction and internal fixation or radial head arthroplasty. This study aimed to assess the functional and radiological outcomes of elbow injuries involving comminuted radial head fractures treated with bipolar radial head arthroplasty.

Methods: We retrospectively analyzed 64 patients, of whom 55 participated in the follow-up, with acute radial head fractures who underwent radial head arthroplasty within two weeks of the injury between March 2009 and June 2015 at a tertiary trauma centre. The primary outcome measure was the Oxford Elbow Score (OES). Secondary outcomes were the short version of Disabilities of Arm, Shoulder and Hand questionnaire, the Mayo Elbow Performance Score, range of motion (ROM), subjective satisfaction, and radiological assessment.

Results: In our study, patient-reported outcome measures indicated good function, minimal pain, and high subjective satisfaction scores. The mean total OES score was 88 (33 to 100; SD 17). In general, patients exhibited good ROM (128° extension-flexion arc), with only minor deficits compared to the unaffected side. Radiological findings commonly included osteolysis around the stem (29 out of 48 patients with available radiographs) and osteoarthritis of the elbow joint (mild in 23 out of 48 patients, severe in nine out of 48).

Conclusion: Comminuted radial head fractures in elbow injuries involving a comminuted radial head fracture can be successfully treated with bipolar radial head arthroplasty. Although radiological changes are frequently observed during follow-up, they do not seem to impact clinical outcomes, and therefore should not be the primary indication for revision surgeries.