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Radial Head Fractures Treated with Open Reduction and Internal Fixation Moghaddam et al. Trauma Cases Rev 2016, 2:028 Volume 2 | Issue 1 ISSN: 2469-5777 Trauma Cases and Reviews Research Article: Open Access Radial Head Fractures Treated with Open Reduction and Internal Fixation Moghaddam A1*, Raven TF1, Kaghazian P1, Studier-Fischer S2, Swing T1, Grützner PA2 and Biglari B2 1Trauma & Reconstructive Surgery, University hospital Heidelberg, Germany 2BG Unfallklinik, Ludwigshafen, Germany *Corresponding author: Prof. Dr. med. Arash Moghaddam, Consultant Orthopaedic & Trauma Surgeon Center of Trauma, Orthopaedics & Paraplegiology, Division of Trauma & Reconstructive Surgery, University hospital Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany, Tel: 0049-6221-5626263, Fax: 0049- 6221-26298, E-mail: [email protected] to a high percentage of associated injuries [6]. The combination of a Abstract dislocated fracture and unstable joint makes operative treatment as Background: Radial head fractures are responsible for 2 to 5% of well as early mobilization difficult. Other treatment options include adult fractures. Especially problematic is the treatment of dislocated the implantation of a radial head prosthesis and resection of the and unstable fractures which often have a worst prognosis. The radial head. The radial head prosthesis has become established as the purpose of this study was to evaluate the results of open reduction choice of treatment for multi-fragmented radial head fractures with and internal fixation (ORIF) in the treatment of radial head fractures. associated injuries, while resection of the radial head has increasingly Materials and Methods: Between June 2001 and January 2006, fallen out of use and is now reserved for isolated fractures of the 41 reconstructive surgical procedures were executed. Thirty-seven radial head without associated injuries [7]. The goal of the operative patients were available for follow-up. The average age was 48 treatment is the reconstruction of the joint through anatomical years and the gender relationship was 2:3 (w:m). Fifty-nine percent reduction and functionally stable osteosynthesis with the possibility of patients had associated injuries of the affected elbow. Outcomes were evaluated on the basis of pain, range of motion, radiographic of early mobilization. Open reduction and internal fixation (ORIF) is findings, and grip strength measured with the Jamar Dynamometer. used primarily for Mason II fractures. Its use in Mason III fractures The overall outcome was rated with the functional rating score is reserved for functionally stable fractures. If the reconstruction of described by Radin and Riseborough and Broberg and Morrey, and the radial head is technically not possible, radial head prosthesis or pain was measured with VAS. resections of the radial head are further treatment options [8]. Result: According to the Morrey score, 29 patients (79%) were The radial head is the largest transferor of force in the elbow evaluated as very good and good and 8 patients (22%) as joint; 80% of the force straining the arm at the wrist is transferred satisfactory. An average score of 90 points was recorded. Sixteen from the radius to the humerus [9]. If the radial head is removed, patients (47%) had an extension deficit. humeroulnar stress can reach peaks in the olecranon of up to nine Conclusion: Radial head fractures with associated ligament injures times the body weight [10,11]. of the elbow can lead to enormous disability of the affected arm. Good clinical outcome is often possible in the treatment of simple The radial head becomes especially important for stability when fractures with anatomical reconstruction of the radial head and elbow luxation occurs [12]. Therefore, the reconstruction of the radial treatment of associated injuries combined with early mobilisation. head is attempted when associated injuries are involved. In addition, the resection of the radial head not only can lead to humeroulnar Keywords osteoarthritis, but also additional proximal change in position of the Elbow instability, Radial head, Comminuted, Fracture, Internal radius and a relative ulnar advancement. The resulting incongruence in fixation the distal radioulnar joint can limit mobility of the forearm [2,13-18]. ORIF of the radial head is done in the situation of Mason II Introduction fractures with damage to more than one third of the joint surface The radial head fracture is responsible for 25-33% of injuries of and displacement of over 2 mm, fractures with more than three the elbow, making it the most common fracture of elbow [1,2]. While fragments (Mason III and Mason IV) and in the situation of unstable isolated and minimally dislocated fractures can be successfully treated radial head fractures. with early functional treatment [3,4], dislocated radial head fractures The goal of this study is to validate the clinical and functional often lead to early functional disability of the elbow joint [2,5] due results for reconstruction of the radial head. Citation: Moghaddam A, Raven TF, Kaghazian P, Studier-Fischer S, Swing T, et al. (2016) Radial Head Fractures Treated with Open Reduction and Internal Fixation. Trauma Cases Rev 2:028 ClinMed Received: December 27, 2015: Accepted: January 19, 2016: Published: January 21, 2016 International Library Copyright: © 2016 Moghaddam A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Table 1: Number and spectrum of associated injuries in 37 patients with radial Table 2: Morrey score [5]. head fractures. The Morrey score has a maximum of 100 points, including points for the following: Associated injuries pain (max. 30 points for no pain at all), function (max. 12 points for no limitations Number Percent in daily life), mobility (max. 37 points for no restrictions of movement), strength (n = 37) (max. 15 points), and stability (max. 6 points). Results are scored accordingly: very good (100-95 points), good (94-80), satisfactory (79-50), poor (≤ 49). With associated injuries 22 59% Without associated injuries 15 41% Pain (max. 30 points) Type of associated injury • No pain 30 points Elbow luxation with injury to the coronoid process 9 24% • Some pain, no pain medication 25 points Isolated injury to the collateral ligaments 3 8% Elbow luxation without injury to the coronoid process 2 5% • Some pain, daily medication 15 points Capitullum fracture 2 5% • Severe pain 5 points Rupture of the anular ligament 2 5% • Unbearable pain 0 points Monteggia-fracture 2 5% Strength (max.15 points) Wrist injury 2 5% • Distal radius fracture 1 3% Flexion Max.5 points • Extension Max.4 points Materials and Methods • Pronation Max.3 points • Study collective Supination Max.3 points Mobility (max.37 points) Between June 2001 and January 2006, 41 reconstructive surgical • Flexion Max. 17 points procedures were executed. Thirty-seven patients were available for • follow-up. The average age was 48 years (Median, 50; range, 20- Extension Max. 8 points 73) and the gender relationship was 2:3 (w:m). The average follow- • Pronation Max. 6 points up period was 35 months (27; 12-60). The left upper extremity was • Supination Max. 6 points affected in 21 cases (57%)-three dominant sided injuries-and the right Stability (max. 6 points) upper extremity in 16 cases (43%)-14 dominant sided injuries. • Anterior/posterior Max. 3 points Fracture classification • Medial/lateral Max. 3 points Fractures were classified according to Mason [19] (modified by Function (max. 12 points) Max. 12 points Broberg and Morrey [5]). Besides routine AP and lateral X-ray images, • Put hands in back pockets Greenspan images [20] of the elbow were also taken. In addition, the AO classification [21] was used. Results yielded 16 (43%) Mason II, • Stand up from chair 10 (27%) Mason III, and 11 (29%) Mason IV fractures. Twenty-two • Use the restroom alone patients had associated injures of the affected extremity Table( 1). • Wash the opposite armpit Data collection • Eat with silverware Demographic data was collected on age, gender, occupation, • Comb hair cause of injury as well as localization of the injury and extent of • Bear weight with bent arm associated injuries. In 22 patients (59%), there was direct injury to the • Cloth oneself affected elbow; in 15 cases (41%) a fall on the outstretched arm was recorded. Injury in 41% of patients was due to commuting or work • Pull with the arm related injuries. Sport related injuries occurred in 19% of patients. • Daily activities are possible In 16% of patients was due to road accidents, 24% to leisure time or • Sport domestic context related injuries. • Throw Associated injuries Results In the patient collective, 59% of patients had associated injuries • 95-100 points Very good on the affected elbow (Table 1). The most common injury was a • 80-94 points Good coronoid fracture due to elbow dislocation, followed by injuries to • 50-79 points Satisfactory the collateral bands (37%). Sixteen patients had various combinations of associated injuries. • ≤ 49 points Poor Operative care to a point three centimeters distally. The fascia between the Extensor Thirty patients (78%) were treated with ORIF and the use of two carpi ulnaris and anconeus as well as the articular capsule and anular mini-screws. Three patients (8%) received ORIF with Poly-Pins. The ligament were split to expose the radial head. A careful reduction and mini-T-plate was used in four patients (11%). In addition, damage temporary fixation through the use of forceps or K-wires was done, to the ligament structures required refixation with a Mitek-hook. so that the plate could be placed, and then it was fixated with locking In coronoid fractures, stabilization occurred with a screw from the screws. Associated injuries to ligaments and bone were reconstructed opposite corticalis; smaller bone fragments were refixated with a and intraoperative mobility and stability were tested to ensure that Mitek-hook. A fixator was used if joint instability was observed 22[ ].
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