Document Type : RESEARCH PAPER
Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
Orthopedics and Traumatology Department, British Hospital, Montevideo, Uruguay
Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Background: The purpose of this case series is to describe surgical decision making and clinical outcomes in posteriorly
displaced radial head fractures with a major fragment (more than 50% of the head) located behind the humeral condyle.
We also document the outcome of open reduction and internal fixation of completely displaced radial head fractures.
Methods: A retrospective review of the ICUC® (Integrated Comprehensive Unchanged Complete) database was
performed between 2012 and 2020. Patients were included if preoperative radiographs demonstrated a major radial
head fracture fragment located posterior to the humeral condyle and a minimum of 2-year follow-up data was available.
Results: Ten patients met inclusion criteria. Two patients had an associated elbow dislocation whereas 8 patients did
not. All patients were found to have disruption of the lateral collateral ligament complex intraoperatively. Nine radial
head fractures were successfully fixed with interfragmentary screws. One multi-fragmented radial head fracture could
not be successfully stabilized with interfragmentary screw fixation and was resected. The average time to final followup was 4.8 years (range 2.2-8.1). At final follow-up, 6 patients demonstrated radiographic evidence of a healed radial
head, 1 patient had avascular necrosis, and 2 had post-traumatic arthritis. None demonstrated radiographic instability.
The average functional score was 0.64 (SD 0.81) and pain score was 0.45 (SD 0.93). The average elbow extension
was 8 degrees (SD 11), elbow flexion was 139 degrees (SD 6), forearm supination was 60 degrees (SD 27), and
forearm pronation was 69 degrees (SD 3).
Conclusion: Recognition of a posteriorly displaced radial head fracture is essential, as it may be an indirect sign of
elbow instability. This instability should be addressed during surgical intervention.
Level of evidence: IV