Does ORIF of Multifragmentary Fractures of the Radial Head Lead to Poor Outcomes?
Phillip C. McKegg, MS1; Genaro A. Deleon, MS1; Nathan O'Hara, MHA1; Qasim M. Ghulam, MS1; Zachary D. Hannan, BS1; Christopher Langhammer, MD, PhD1; Raymond Pensy, MD2; Robert O'Toole, MD1; Lucas Marchand, MD3; Gerard Slobogean, MD4; W Andrew Eglseder, MD2
1R Adams Cowley Shock Trauma Center, Baltimore, MD; 2University of Maryland School of Medicine, Baltimore, MD; 3University of Utah, Salt Lake City, UT; 4University of Maryland, Baltimore, MD
Surgical treatment of radial head fractures, particularly those comprised of 3 or more fragments, remains a controversial topic. We aimed to analyze and compare complications, range of motion, and the presence of pain at final follow-up in patients with radial head fractures that underwent open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA). We hypothesized that ORIF would be associated with better outcomes compared to RHA.
The study included adult patients with a radial head fracture treated with either ORIF or RHA at a level one trauma center from 2007-2018. The primary outcome was a post-operative complication, defined as stiffness, contracture, heterotopic ossification, retained hardware, loss of fixation, nonunion, or malunion. Secondary outcomes included range of motion and the presence of pain at the last follow up. The association between treatment and the study outcomes was tested using generalized linear models, which controlled for age, comminution, dislocation, fracture type, Mason type, and the number of radial head fragments. A subgroup analysis was performed in patients with 3 or more fragments.
The study included 221 patients treated with ORIF and 79 with RHA. The mean age was higher in the RHA group (60 vs. 42 years, p<0.01). The RHA group also had a higher proportion of female patients (72% vs. 35%, p<0.01), and patients with 3 or more fragments 61% vs. 38%, p<0.01). In the subgroup with 3 or more fragments, 80 underwent ORIF and 45 underwent RHA. Of these, 23.8% of the ORIF patients experienced a post-operative complication compared to 24.4% of RHA patients (p=0.45). One patient experienced nonunion and one patient experienced malunion of the radial head in the ORIF group. 65% of ORIF patients and 64.4% of RHA patients were able to achieve a >100-degree arc of forearm rotation at final follow-up (p=0.24). Pain at last follow-up was lower with RHA (46.7% vs 55%) but not statistically significant (p=0.16). The results in the subset were consistent with the full sample.
For radial head fractures, treatment with ORIF and RHA demonstrate similar outcomes whether or not the radial head is fractured in three or more fragments. Although this is one of the largest retrospective reviews to date comparing these two treatments for this fracture type, long-term, prospective studies should be conducted to account for treatment selection bias and late onset complications, such as loss of fixation or prosthetic loosening.
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