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Operative Management of Unstable Radial Head Fractures in a Young Active Population
Nicholas Kusnezov, MD1; Emmanuel David Eisenstein, MD2; Justin S Mitchell, DO2; Kelly G Kilcoyne, MD2; Brian R Waterman, MD2
1Orthopaedic Surgery, Texas Tech University Medical Center, El Paso, TX, 2William Beaumont Army Medical Center, El Paso, TX
Introduction: The purpose of this study was to determine the rate of return to function, complications, and re-operation following operative management of unstable radial head fractures in a young, active patient population with intense upper extremity demands.
Methods: A military healthcare database was queried for all United States military servicemembers undergoing ORIF [Current Procedural Terminology (CPT) code 24665)] and RHA (CPT 24666) between 2010 and 2015. All patients with minimum two-year follow-up were included. Univariate and multivariate analyses were performed to evaluate the association between potential risk factors and the primary outcomes to include ability to return to duty and final range of motion.
Results: Sixty-seven ORIF (n=69 elbows) and 10 RHA patients were included. The average age was 31±8.0 years. At mean follow-up of 3.5±1.1 years, 90% of patients overall were able to return to active military service, 96% of which resumed unrestricted upper extremity function. One-third (33.8%) of patients developed at least one postoperative complication, with RHA demonstrating higher rates of implant failure and overall complication rates. Eighteen (23%) individuals required reoperation, including five (6.3%) with revision surgery. Dislocation, coronoid fracture and concomitant ligamentous repair was associated with a significantly higher risk of developing one or more complications, while dislocation and requirement for ligamentous repair predicted revision surgery. Coronoid fracture independently predicted loss of supination, while dislocation trended towards having one or more revisions. Mason III fractures independently predicted a decrease in pronation compared to Mason II patterns.
Conclusion: Arthroplasty and ORIF are both viable options for treating unstable radial head fractures in a young, athletic population, offering comparable return to function despite increased risk of adverse clinical outcomes with RHA. Level of Evidence: Level III, Therapeutic retrospective comparative study Key Words: complications; functional outcomes; open reduction internal fixation; radial head arthroplasty; radial head fracture
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