Radial Head Resection versus Arthroplasty in Unrepairable Comminuted Fractures Mason Type III and Type IV: A Systematic Review

Abstract

Unrepairable comminuted fractures of the radial head Mason type III or type IV have poor outcomes when treated by open reduction and internal fixation. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacement. The present review was conducted to determine the best surgical treatment for comminuted radial head when ORIF is not possible. Better outcomes are reported for radial head arthroplasty in terms of elbow stability, range of motion, pain, and fewer complications compared to radial head excision. Nevertheless, radial head resection still can be considered an option of treatment in isolated radial head fractures with no associated ligament injuries lesion of ligaments or in case of older patients with low demanding function.

Polylactide pins can effectively fix severely comminuted and unsalvageable radial head fracture: A retrospective study of 40 patients

“…plates and screws, and cause a higher rate of failure of fixation, nonunion and osteonecrosis (13). This type of fracture is defined as "unsalvageable" or "unrepairable" radial head fractures (6,14) and are usually treated by radial head resection or arthroplasty.…”

“…So radial head arthroplasty has become the most popular treatment for such fractures. A wide variety of prostheses is available that is effective in preventing proximal migration of the radius which can increase dynamic stability of the elbow joint and DRUJ (5,6). Although radial head arthroplasty results in favorable outcomes, a number of mid to long-term retrospective studies have demonstrated that a considerable proportion of patients who undergo arthroplasty ultimately experience complications such as capitellum erosion, elbow joint arthrosis and loosening of the prosthesis (7)(8)(9).…”

Functional outcomes evaluation after radial head arthoplasty in DR. Syaiful Anwar General Hospital: Case series

“…Radial head arthroplasty (RHA) becoming a more popular option in recent years for the treatment of radial head fracture Mason type III and IV. Many studies state that RHA showed a superior result compared to radial head resection and open reduction and internal fixation, but some were against it, stating that the latter option is better in term of functional outcomes, number of revision surgery and post-operative early and late complications [ 1 , 3 , 4 , 7 , 8 ].…”

“…Catellani et al said that few papers recommend resection as a better option for isolated radial head fractures unassociated with ligaments injuries because of a lack of statistical clinical differences between RHA and radial head resection. No substantial differences in patient outcomes at medium and long-term follow-up [ 3 ]. A similar study from Akman et al show that resection arthroplasty is an effective method for the treatment of isolated comminuted radial head fractures because of the less demanding technique [ 8 ].…”

“…Decreasing grip strength, cubitus valgus, proximal migration of radius and longitudinal instability, and ulnar neuropathy has been described by many researchers as a daunting complications of radial head resection. Because of that, many orthopaedic surgeons favor radial head arthroplasty as primary option of treatment in radial head fractures, ultimately for Mason type III and IV [ 3 ].…”