Mason type III fractures of the radial head: ORIF, resection or prosthetic replacement?

Abstract

Purpose This study focused on a comparison of mid-term clinical, functional and radiographic outcomes of adults treated by open reduction and internal fixation (ORIF), radial head prosthesis (RHP) and resection (RHR). Methods The retrospective evaluation concerned 47 surgically treated patients after a mean follow-up of 53 months. All patients were grouped according to the surgical procedure performed: 15 in the RHP group, 16 in the ORIF group and 16 in the RHR group. At the follow-up, outcome assessment was based on radiographs, range of motion (ROM) and functional rating scores. Results Patients treated by RHR had significantly higher mean age and shorter operation time than other two groups. Compared to ROM, flexion, extension and pronation were significantly worse in patients treated by ORIF than those in the RHP group and the RHR group. Supination was significantly better in the RHP group. However, no statistical differences were observed in functional rating scores among the three groups. Regarding complications, instability was the only cause of revision surgery in the RHP group and the RHR group. On the other hand, the ORIF group revision rate was 50% and secondary displacement was the most frequent cause of failure. Conclusion The ORIF group did not show good results with greater elbow stiffness and higher revision rate than the other two techniques. RHR may be suitable for elderly patients with lower functional demands as it reported good clinical results and reduced operation time.

Functional Postoperative Outcome for 92 Cases of Radial Head Fractures: A PROM-Based Retrospective Study

“…There are several studies investigating the outcome after radial head fractures. Nevertheless, most studies only compare different treatment options for the same fracture type according to the Mason classification [ 7 , 11 , 15 , 16 , 17 ]. Sufficient data about the functional outcome comparing different Mason fracture types are still lacking in the current literature.…”

“…The overall outcome after radial head fractures shows good results not only for conservatively treated Mason I fractures [ 9 ] but also for complex Mason III types treated with radial head resection, prosthesis, or reconstruction [ 10 , 11 ]. However, the number of studies evaluating the functional outcome following radial head fractures is limited.…”

Radial head arthroplasty vs. open reduction and internal fixation for the treatment of terrible triad injury of the elbow: A systematic review and meta‑analysis update

“…After analysis, it was found that a total of 189 cases underwent RHA and 266 cases underwent ORIF in the included literature. Most of the patients in the RHA group had Mason type III fractures caused by high-energy injury ( 37 ), and their soft tissue conditions were poor, which may be one of the reasons why the RHA group did not have a significant advantage in postoperative functional scores compared with ORIF. It has also been shown that early elbow surgery is one of the influencing factors for restoration of elbow function ( 38 ), and the soft tissue edema caused by the severe injury in the RHA group was likely to delay the optimum time for surgery, so it could be difficult to achieve the desired functional efficacy.…”