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Outcomes of Radial Head Fractures in Patients Under 50 Years Old: What's Better ORIF or Arthroplasty?
Sanmeet Singh, BS1; Xuyang Song, MS2; W. Andrew Eglseder, MD2; Raymond Pensy, MD2; Joshua Abzug, MD2
1School of Medicine, Howard University, Washington D.C, DC; 2Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD

Introduction: Arthroplasty has been recommended for radial head fractures with more than three articular fragments due to increased complications with ORIF, including nonunion and loss of forearm rotation. However, the active lifestyles of patients under 50 years of age may not be in line with replacement of their radial heads. The purpose of this study is to evaluate the outcomes of radial head fractures in patients under 50 years of age to determine which treatment may be more appropriate, replacement or ORIF.

Materials & Methods: A retrospective review of radial head fractures over a 6-year period from a level 1 trauma center was performed on patients aged 18-50 years. Data collected included patient demographics, age of patient at the time of surgery, the number of fragments, Mason classification, the presence of any associated soft tissue injuries, dislocations, or other fractures, the need for bone grafting, implant type if replacement was performed, and outcomes data including, range of motion (ROM), complications, and conversion to replacement.

Results: 35 patients were included in the study with an average follow-up of 8.5 months. 35% (13/35) had greater than three articular fragments. 85% (11/13) of this subset underwent open reduction and internal fixation, with only 15% (2/13) undergoing prosthetic replacement. The average postoperative ROM in the ORIF group was 67.8 degrees of pronation and 61.6 degrees of supination. None of the patients who underwent ORIF (0/11) went on to nonunion, malunion, or failure of the hardware. 36% (4/11) had removal of their hardware, capsulectomy, and excision of heterotrophic ossification to improve post-operative range of motion. No patients (0/11) in the greater than three fragment group that underwent ORIF required conversion to a radial head replacement.

Conclusions: The notion that “smashed” radial head fractures (those with more than 3 articular fragments) need to have a replacement performed may not be optimal for patients under 50 years of age. Treatment of young patients with ORIF of a “smashed” radial head can lead to excellent outcomes with a low complication rate. Better understanding of the specific fracture patterns that may occur as well as patient demands may help guide surgeons in choosing which treatment to perform for “smashed” radial head fractures in young patients.

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