Long-term Outcomes after Primary Radial Head Resection Arthroplasty vs. Acute Radial Head Resection vs. Secondary Prosthetic Removal in Comminuted Radial Head Fractures

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

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