Comparing Radial Head Fracture Surgical Outcomes in Patients Younger and Older Than Forty.

Objectives: To compare the results of radial head arthroplasty(RHA) and open reduction internal fixation (ORIF) for radial head fracture treatment based on patient age.

Methods: Design: Retrospective cohort study.

Setting: Two academic Level 1 Trauma centers.

Patient selection criteria: Included were patients treated with RHA or ORIF for a radial head fracture (OTA/AO 2R1A/B/C) between January 2015 and September 2022.

Outcome measures and comparisons: Postoperative surgical outcomes, including reoperations, final elbow range of motion (ROM), and radiographic features were collected. The outcomes of RHA and ORIF in patients above and below 40 years were compared using bivariate and multivariable regression analyses.

Results: The study cohort included 161 operative radial head fractures sustained in 160 patients of which 47% were male (n=75). Thirty-two patients were included in the RHA <40 years group (mean age 31 years, standard deviation (SD) 5; 72% were male (n=23)), 96 patients in the RHA ≥40 years group (mean age 60 years, SD 11; 34% were male (n=33)), and 22 patients in the ORIF <40 years group (mean age 27 years, SD 6; 64% were male (n=14)). In patients <40 years old, RHA versus ORIF had comparable flexion-extension (125° versus 128°, p=0.79) prono-supination (145° versus 140°, p=0.16), and reoperation rate (22% versus 14%, p=0.50). Rates of post-traumatic arthritis were higher for RHA versus ORIF in this age group (57% versus 27%, p=0.047), although the follow-up period for radiographic assessment in the RHA <40 years group was slightly longer than the ORIF <40 years group (12.7±10.4 months versus 7.6±4.6 months, p=0.04). When comparing patients ≥40 years old with those <40 years old, outcomes of RHA had comparable flexion-extension (125° versus 125°, p=0.93) prono-supination (145° versus 150°, p=0.07), reoperation rate (22% versus 15%, p=041), and post-traumatic arthritis rate (57% versus 64%, p=0.34). Younger patients exhibited a lower frequency and severity of stem radiolucency than older patients (53% versus 67%, p=0.01).

Conclusions: For patients under 40 years, ORIF and RHA yielded comparable outcomes. RHA had a higher risk of post-traumatic arthritis, favoring ORIF for younger patients if technically feasible. Older patients should be aware of the increased risk of stem lucency when undergoing RHA.

Level of evidence: Level III, retrospective cohort study.