Fractures of the Radial Head and Neck

Abstract

The majority of simple fractures of the radial head are stable, even when displaced 2 mm. Articular fragmentation and comminution can be seen in stable fracture patterns and are not absolute indications for operative treatment. Preservation and/or restoration of radiocapitellar contact is critical to coronal plane and longitudinal stability of the elbow and forearm. Partial and complete articular fractures of the radial head should be differentiated. Important fracture characteristics impacting treatment include fragment number, fragment size (percentage of articular disc), fragment comminution, fragment stability, displacement and corresponding block to motion, osteopenia, articular impaction, radiocapitellar malalignment, and radial neck and metaphyseal comminution and/or bone loss. Open reduction and internal fixation of displaced radial head fractures should only be attempted when anatomic reduction, restoration of articular congruity, and initiation of early motion can be achieved. If these goals are not obtainable, open reduction and internal fixation may lead to early fixation failure, nonunion, and loss of elbow and forearm motion and stability. Radial head replacement is preferred for displaced radial head fractures with more than three fragments, unstable partial articular fractures in which stable fixation cannot be achieved, and fractures occurring in association with complex elbow injury patterns if stable fixation cannot be ensured.

Nonsurgical treatment of Mason type II radial head fractures in athletes. A retrospective study

“…In 1979 (27) and then in 1988 (28) Morrey et al demonstrated that the radial head contributes to the valgus, varus and posterolateral rotatory stability of the elbow and acts as an axial stabilizer of the forearm; because of these biomechanical studies and along with significant improvement in surgical techniques and instrumentation, open reduction and internal fixation has become the preferred treatment for Mason type II fractures. At present, a fracture fragment displacement of ≥ 2 mm is usually used as a criterion for operative treatment (29); as a matter of fact, different parameters should be taken into account when planning the best treatment to perform (30,31): type of fracture, displacement, fragment stability, magnitude of articular involvement, and presence of associated complex injuries. In the case of a stable and isolated Mason type II fracture, mid-and long-term follow up studies have demonstrated that nonsurgical treatment can provide good or excellent functional outcome in the vast majority of cases (32,33,34,35).…”

Assessment of Intra-articular Screw Penetration During Radial Head and Olecranon Locking Plate Fixation

“…Previous studies have documented the anatomical variance of the proximal radius and ulna and have aimed at establishing guidelines to achieve proper osteosynthesis and avoid proximal radioulnar joint (PRUJ) impingement. 10,23,28 Inadvertent intra-articular screw penetration can lead to early joint degeneration, pain, and loss of function. 24 Lindenhovius et al evaluated 16 patients who underwent plate fixation for fractures of the radial head.…”

Comparison of the Functional Results of Radial Head Resection and Prosthesis for Irreparable Mason Type III Fracture

“…Various treatment options are available, depending on fracture severity. [5,6] Although biological treatment modalities, such as conservative methods and open reduction and internal fixation, are first-choice treatments, [7] especially for Mason Type-III fractures, the optimum treatment method remains controversial. [5,6] Results of radial head resection (RHR) [8,9] and radial head prosthesis…”