Document Type: RESEARCH PAPER

Authors

1 Department of Trauma Surgery, BG Trauma Center Murnau, Germany

2 Department of Trauma Surgery, BG Trauma Center Murnau, Germany Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria

Abstract

Background: Aim of this study was to compare the clinical and radiological long-term outcomes following operative
treatment of comminuted radial head fractures using 1) primary radial head resection arthroplasty, 2) acute radial head
resection, or 3) necessary secondary prosthetic removal. Additionally, we evaluated complex radial head fractures
combined with elbow dislocation and verified the hypothesis of whether primary radial head resection arthroplasty could
contribute to ligament healing.
Methods: In a comparative retrospective cohort study between 2004 and 2014, 87 (33 female, 54 male) patients with
comminuted radial head fractures with a median age of 45 (range 18-77) years were included and followed-up clinically
and radiologically. Functional results were evaluated according to MEPS, DASH, Broberg and Morrey, and VAS scores.
Results: After a median range of 46 months postoperatively, 48 patients (group 1) obtained an acute radial head
resection arthroplasty (MEPS: 70 points, Broberg and Morrey: 63 points, DASH: 34 points, VAS: 3.3 points). Twenty
patients (group 2) were treated by radial head resection (MEPS: 63 points, Broberg and Morrey: 50 points, DASH: 49
points, VAS 4.2 points) and 19 patients (group 3) needed secondary prosthesis removal (MEPS: 73 points, Broberg
and Morrey: 66 points, DASH: 38 points, VAS: 2.8 points). The overall outcome demonstrated a trend towards better
results and the Kellgren-Lawrence grade of postoperative osteoarthritis was significantly better in groups 1 and 3
compared to group 2 (P=0.02).
Conclusion: Clinical and radiological long-term results of this study demonstrate a trend towards a better outcome
after acute radial head resection arthroplasty compared to primary radial head resection, especially in complex fractures
associated with elbow dislocation. Furthermore, our results encourage the use of primary radial head replacement in
cases of comminuted non-reconstructable radial head fractures.
Level of evidence: III

Keywords

Main Subjects

1. Estrada-Malacon CA, Perez-Valtierra M, Torres-Zavala
A, Fonseca-Bernal M. Hemiarthroplasty of the radial
head in patients with Mason Johnston types III and IV
fracture. Acta Ortop Mex. 2015; 29(3):148-54.
2. Duckworth AD, McQueen MM, Ring D. Fractures of the
radial head. Bone Joint J. 2013; 95-B(2):151-9.
3. Charalambous CP, Stanley JK, Mills SP, Hayton MJ,
Hearnden A, Trail I, et al. Comminuted radial head
fractures: aspects of current management. J Shoulder
Elbow Surg. 2011; 20(6):996-1007.
4. Ring D. Radial head fracture: open reduction-internal
fixation or prosthetic replacement. J Shoulder Elbow
Surg. 2011; 20(2 Suppl):S107-12.
5. Herbertsson P, Josefsson PO, Hasserius R, Besjakov J,
Nyqvist F, Karlsson MK. Fractures of the radial head 

and neck treated with radial head excision. J Bone
Joint Surg Am. 2004; 86-A(9):1925-30.

6. Iftimie PP, Calmet Garcia J, de Loyola Garcia Forcada
I, Gonzalez Pedrouzo JE, Gine Goma J. Resection
arthroplasty for radial head fractures: long-term
follow-up. J Shoulder Elbow Surg. 2011; 20(1):45-50.
7. Duckworth AD, Wickramasinghe NR, Clement
ND, Court-Brown CM, McQueen MM. Radial head
replacement for acute complex fractures: what are
the rate and risks factors for revision or removal? Clin
Orthop Relat Res. 2014; 472(7):2136-43.
8. Sun H, Duan J, Li F. Comparison between radial head
arthroplasty and open reduction and internal fixation
in patients with radial head fractures (modified
Mason type III and IV): a meta-analysis. Eur J Orthop Surg Traumatol. 2016; 26(3):283-91.

9. Zunkiewicz MR, Clemente JS, Miller MC, Baratz ME,
Wysocki RW, Cohen MS. Radial head replacement
with a bipolar system: a minimum 2-year follow-up. J
Shoulder Elbow Surg. 2012; 21(1):98-104.
10. Zarifian A, Rahimi Shoorin H, Hallaj Moghaddam M,
Fathi Vavsari M, Gharedaghi M, Moradi A. The best
option in treatment of modified mason type iii radial
head fractures: open reduction and internal fixation
versus radial head excision. Arch Bone Jt Surg. 2018;
6(5):365-70.
11. Chen X, Wang SC, Cao LH, Yang GQ, Li M, Su JC.
Comparison between radial head replacement and
open reduction and internal fixation in clinical
treatment of unstable, multi-fragmented radial head
fractures. Int Orthop. 2006; 35(7):1071-6.
12. Ruan HJ, Fan CY, Liu JJ, Zeng BF. A comparative study
of internal fixation and prosthesis replacement for
radial head fractures of Mason type III. Int Orthop.
2009; 33(1):249-53.
13. Lindenhovius AL, Felsch Q, Doornberg JN, Ring D, Kloen
P. Open reduction and internal fixation compared with
excision for unstable displaced fractures of the radial
head. J Hand Surg Am. 2007; 32(5):630-6.
14. Wu PH, Shen L, Chee YH. Screw fixation versus
arthroplasty versus plate fixation for 3-part radial
head fractures. J Orthop Surg (Hong Kong). 2016;
24(1):57-61.
15. Burkhart KJ, Mattyasovszky SG, Runkel M, Schwarz
C, Kuchle R, Hessmann MH, et al. Mid- to long-term
results after bipolar radial head arthroplasty. J
Shoulder Elbow Surg. 2010; 19(7):965-72.
16. Grewal R, MacDermid JC, Faber KJ, Drosdowech DS,
King GJ. Comminuted radial head fractures treated
with a modular metallic radial head arthroplasty.
Study of outcomes. J Bone Joint Surg Am. 2006;
88(10):2192-200.
17. Laun R, Wild M, Hakimi M. One-year results of
cemented bipolar radial head prostheses for
comminuted radial head fractures. GMS Interdiscip
Plast Reconstr Surg DGPW. 2015; 4(Doc12):1-7.
18. van Riet RP, Sanchez-Sotelo J, Morrey BF. Failure of
metal radial head replacement. J Bone Joint Surg Br.
2010; 92(5):661-7.
19. Neuhaus V, Christoforou DC, Kachooei AR, Jupiter JB,
Ring DC, Mudgal CS. Radial head prosthesis re-moval:
a retrospective case series of 14 patients. Arch Bone Jt
Surg. 2015; 3(2):88-93.
20. Keats AS. The ASA classification of physical status--a
recapitulation. Anesthesiology. 1978; 49(4):233-6.
21. Broberg MA, Morrey BF. Results of treatment of
fracture-dislocations of the elbow. Clin Orthop Relat
Res. 1987; 216(1):109-19.
22. Hudak PL, Amadio PC, Bombardier C. Development
of an upper extremity outcome measure: the
DASH (disabilities of the arm, shoulder and hand)
[corrected]. The Upper Extremity Collaborative Group
(UECG). Am J Ind Med. 1996; 29(6):602-8.
23. Aitken RC. Measurement of feelings using visual
analogue scales. Proc R Soc Med. 1969; 62(10):989-93.
24. Kellgren JH, Lawrence JS. Radiological assessment of
osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):494-502.
25. Ryf C, Weymann A. The neutral zero method-a
principle of measuring joint function. Injury. 1995;
26(Suppl 1):1-11.
26. Nonnenmacher J, Schurch B. Fractures of the radial
head and lesions of the lower radius and ulna in the
adult: the importance of the prosthesis in resection.
Ann Chir Main. 1987; 6(2):123-30.
27. Clembosky G, Boretto JG. Open reduction and internal
fixation versus prosthetic replacement for complex
fractures of the radial head. J Hand Surg Am. 2009;
34(6):1120-3.
28. Vanni S, Marenco S, Calo M, Battiston B. Resection
arthroplasty after failure of a radial head prosthesis: a
case report. Case Reports Plast Surg Hand Surg. 2016;
3(1):28-31.
29. Doornberg JN, Parisien R, van Duijn PJ, Ring D. Radial
head arthroplasty with a modular metal spacer to
treat acute traumatic elbow instability. J Bone Joint
Surg Am. 2007; 89(5):1075-80.
30. Harrington IJ, Sekyi-Otu A, Barrington TW, Evans
DC, Tuli V. The functional outcome with metallic
radial head implants in the treatment of unstable
elbow fractures: a long-term review. J Trauma. 2001;
50(1):46-52.
31. Smets S, Govaers K, Jansen N, Van Riet R, Schaap M,
Van Glabbeek F. The floating radial head prosthesis
for comminuted radial head fractures: a multicentric
study. Acta Orthop Belg. 2000; 66(4):353-8.
32. Yalcinkaya M, Bagatur AE, Erdogan S, Zorer G. Resection
arthroplasty for Mason type III radial head fractures
yield good clinical but poor radiological results in the
long term. Orthopedics. 2013; 36(11):e1358-64.
33. Butler MA, Holt GE, Crosby SN, Weikert DR. Late
posterior interosseous nerve palsy associated with
loosening of radial head implant. J Shoulder Elbow
Surg. 2009; 18(6):e17-21.