Management of Radial Head Fractures: Current Concepts

Abstract

Radial head fractures are common injuries and are accompanied by clinically relevant associated injuries in over one-third of patients. They are commonly classified by the Mason classification or one of its modifications. Type I fractures are treated conservatively with early mobilization. Type II fractures can be treated conservatively or by open reduction and internal fixation (ORIF), depending on fragment size and dislocation. Bony restriction in forearm rotation is an indication for surgical treatment. Type III fractures are treated surgically, by means of ORIF, prosthetic replacement or excision. Comminuted fractures with more than three fragments are regarded as unsuitable for ORIF. However, optimal treatment of type II and III fractures is still the subject of debate and there is a strong need for randomized clinical trials and uniform fracture classification and outcome measures.

Traumatic Elbow Mediolateral Investigatory Screening: The value of the sitting axial mediolateral projection in the diagnosis of radial head fractures

“…10 For more complex fractures, dislocations, associated soft tissue injury or preoperative planning, magnetic resonance imaging and computed tomography should be utilized. 8,9 The standard elbow X-ray series taken to visualize the elbow historically includes an anteroposterior (AP) and a lateral projection. 3,5,8,11 As conventional projections do not always provide results of diagnostic value modified views such as the external and medial oblique, supracondylar AP, Coyle's method and radial headcapitellum view can assist when a fracture is still suspected.3e5 ,11,12 Therefore, when conventional imaging does not identify a fracture but clinical suspicion is high, clinicians can employ modified techniques.…”

“…6,7 They are treated conservatively with a good outcome; never the less they should not be underestimated as their complications can be severe and despite recovery movement might not be fully regained. 7,8 Complications include stiffness, development of post-traumatic osteoarthritis, permanent instability of the elbow and loss of joint function (flexion, extension, supination or pronation). 1e7 Treatment includes early mobilization, results being better when there is an initial twoday immobilization period (collar and cuff sling).…”

“…The standard elbow series involves an anteroposterior (AP) and a Lateral projection of the elbow. 3,5,8,11 Never the less, it has been noted that conventional Xray imaging is not always sufficient to depict all radial head fractures as the ulna's overlapping on the radial head does not always allow for its distal part to be seen on an AP projection. 2 Similarly, in the lateral projection the distal portion of the radial head is obstructed by superimposition of the humero-radial and humeroulnar joints.…”

Radial Head Fractures: Mason Johnston's Classification Reproducibility

“…Some studies have focussed on the inter-and intra-observer concordance of various classification systems relating to radial head fractures 7 . Sheps et al 4 , assessed the reproducibility of classification systems for radial head fractures (AO Classification and the Hotchkiss modification of the Mason Classification) and concluded that the AO classification was fair according to the criteria of Landis and Koch.…”

Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study

“…Although previous guidelines suggested that Mason type II fractures with the fracture fragment involving more than 25% of radial head were best treated by reduction and fixation [2], indications for fixation have evolved [3] and opinions differ as to the best method of fixation [3]. Management of Mason type III fractures is equally controversial, with management options including conservative management, simple excision [4], prosthetic implant replacement [5,6], and open reduction and internal fixation [2]. Resection of radial head fracture is a very attractive option because of its ease, shorter duration of surgery, and absence of any implant related complications.…”