Mason Type I Fractures of the Radial Head

Keizer, R.J.; Walenkamp, Monique M. J.; Goslings, J. Carel; Schep, N.W.L.

doi:10.3928/01477447-20151123-06

Cited by 12 publications

(15 citation statements)

References 64 publications

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“…In clinical practice conventional radiographs (CR) represent the gold standard of radiologic examination and provide an essential element for radial head fracture classification [27]. Nevertheless, the sensitivity of plain radiographs has been shown to be as low as 21%, at least for simple elbow fractures in a cadaver study [28].…”

Section: Discussionmentioning

confidence: 99%

The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

Haasters

Helfen

Böcker

et al. 2019

BMC Musculoskelet Disord

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Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% ( p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% ( p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% ( p < 0.001) of the CR and in 18% ( p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% ( p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.

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Section: Discussionmentioning

confidence: 99%

The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

Haasters

Helfen

Böcker

et al. 2019

BMC Musculoskelet Disord

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“…The causes of injury included 66 from falls, 40 from traffic accidents, and 155 from intense collisions. According to the Mason typing of radial head classification [ 15 ] : 62 patients (23.75%) were in type I (marginal fracture without bone block displacement, which was reconstructable); 128 patients (49.04%) in type II (fracture with bone block displacement, which was reconstructable); and 71 patients (27.20%) in type III (comminuted fracture, which was unreconstructable). On the basis of the Regan–Morrey typing of ulna coronoid process of fracture classification, [ 16 ] they were classified as following: type I, 75 patients (28.74%) with avulsion fracture of the coronoid process; type II, 116 patients (44.44%) with a fracture no more than 50% of the entire coracoid process; and type III, 70 patients (26.82%) with a fracture more than 50% of the entire coracoid process.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of effect and safety of arthroscopic surgery with three different operative approaches in patients with terrible triad of the elbow

Li²,

Hu³

et al. 2018

Medicine

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Background:The terrible triad of the elbow (TTE) is a difficult injury, and the usual TTE consists of posterior dislocation of the elbow, radial head fracture, and coronoid fracture. The target of this retrospective study is to explore the effect, postoperative complications, and prognostic factors in patients with TTE undergoing arthroscopic surgery with three different operative approaches.Methods:Patients with TTE underwent arthroscopic surgery were treated using lateral, anterior medial, or combined lateral and anterior medial approaches, respectively. In order to analyze the postoperative complications and the effect of arthroscopic surgery for patients with TTE, the function of elbow joint before and after the surgery was evaluated and the flexion-extension of elbow joint and rotation of elbow joint and forearm were measured.Results:The evaluation results obtained from patients underwent 3 different operative approaches revealed that after surgery, patients receiving arthroscopic surgery using combined lateral and anterior medial approach had superior flexion-extension of elbow joint, rotation of elbow joint and forearm, higher Mayo Elbow Performance Score (MEPS) and more cases of Broberg–Morrey grade 0, and lower complication rate, compared with those using lateral or anterior medial approach. A key finding in the study demonstrated that fracture type, operative approach, and postoperative complications were factors related with the effect of arthroscopic surgery for patients with TTE.Conclusion:Collectively, the key findings obtained from the present study supported the notion that the effect of arthroscopic surgery in combined lateral and anterior medial approach is much better than in lateral approach or anterior medial approach, and is related with fracture type, operative approach, and postoperative complications.

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“…2). If no displaced fracture is present, an anterior or posterior fat pad sign seen on a lateral radiograph can indicate a non-displaced radial head fracture [7]. Additional radiographs of the ipsilateral extremity as well as of other ex- tremities should be obtained if the physical examination warrants this.…”

Section: Imagingmentioning

confidence: 99%

“…There is agreement that for Mason I fractures, nonoperative treatment results in excellent outcomes and is the treatment of choice [1,7,11]. Successful nonoperative treatment requires early mobilization of the elbow to avoid stiffness.…”

Section: Mason Imentioning

confidence: 99%

“…Successful nonoperative treatment requires early mobilization of the elbow to avoid stiffness. In a systematic review of Mason I fractures, a grade A recommendation was made for nonoperative treatment consisting of 48 h of sling immobilization followed by an aggressive mobilization protocol; the authors found that the 48-h immobilization avoided increased pain seen with immediate mobilization and reduced the stiffness seen with longer immobilization [7].…”

Section: Mason Imentioning

confidence: 99%

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Radial head fractures in young, active patients

2020

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The radial head is an important stabilizer of the elbow joint. Radial head fractures are commonly associated with additional injuries to the ligamentous structures of the elbow and can significantly compromise elbow stability. Young patients with radial head fractures are more likely to be male and present after a high-energy mechanism of injury. While not perfect, the Mason classification is the most commonly used classification system and can help to guide the management of radial head fractures. Type I fractures are nondisplaced or minimally displaced (less than 2 mm) and are treated nonoperatively with early mobilization. Type II fractures, which are displaced 2–5 mm, can be treated nonoperatively or with open reduction and internal fixation (ORIF). Type III fractures are comminuted and are most often treated with ORIF or with radial head arthroplasty (RHA). Treatment of fractures with an associated elbow dislocation (Mason type IV) is also with ORIF or RHA depending on the degree of comminution. For all of these injuries, assessment and treatment of associated ligamentous injuries are necessary in conjunction with treatment of the bony injury. Despite a significant body of literature available on radial head fractures, there is controversy regarding the optimal management of type II, III, and IV fractures, especially in young, active patients. Common complications following radial head fractures include stiffness, instability, and posttraumatic osteoarthritis; as such, these injuries can lead to significant disability in young, active patients if not managed appropriately.

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Mason Type I Fractures of the Radial Head

Cited by 12 publications

References 64 publications

The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

Evaluation of effect and safety of arthroscopic surgery with three different operative approaches in patients with terrible triad of the elbow

Radial head fractures in young, active patients

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