Outcomes Analysis of Patients Undergoing Operative Treatment of Radial Head Fractures Using PROMIS
Thomas John Carroll, MD1, Jonathan Minto, MD1, Akhil Dondapati, MD1, Samantha Hoffman, BA1, Warren C Hammert, MD2 and Bilal Mahmood, MD1, (1)University of Rochester, Rochester, NY, (2)Duke University, Durham, NC
Introduction: The purpose of our study is to compare the outcomes of patients undergoing operative treatment of radial head fractures using PROMIS. Our hypothesis is that compared to the open reduction and internal fixation group (ORIF), the radial head arthroplasty (RHA) group will demonstrate earlier functional improvement and higher overall PROMIS Upper Extremity (UE) and Physical Function (PF) scores with lower overall PROMIS Pain Interference (PI) scores at the final 12 month follow up.
Methods: This is a 7-year retrospective study of 143 consecutive patients undergoing operative fixation of radial head fractures (ORIF, RHA, or radial head excision) presenting to a large academic institution. Demographic information, treatment method, PROMIS UE, PF, PI, and patient acceptable symptom state (PASS) were recorded for each patient at the initial, 2 week, 6 week, 12 week, 6 month, and 12 month visits. Statistical analysis was completed using unpaired T-test and Chi-square analysis.
Results: Among the 143 patients, 83 underwent RHA, 47 underwent ORIF, and 13 underwent radial head excision. At initial visit versus at 12 months, 92 patients and 63 patients completed the questionnaire respectively. Among the 47 ORIF patients, compared to pre-op, the 12-month mean PROMIS scores were PF 41.24 (+3.22, p=0.12), and PI 61.97 (-1.56, p=0.45). Among the 83 RHA patients, compared to pre-op, the 12-month mean PROMIS scores were PF 33.42 (-1.33, p=0.39), UE 32.06(-0.3, p=0.6), and PI 61.95 (-1.48, p=0.3). PROMIS PF was significantly higher among the ORIF compared to RHA group at pre-op visit (38.1 vs 34.7, p=0.044), 6 months (42.74 vs 36.97, p<0.01) and 12 month (41.24 vs 33.42, p<0.001). The overall net increase in PROMIS PF was also significantly higher (+3.22 vs -1.326, p<0.01). There was no significant difference in PROMIS PI scores between the two cohorts at pre-op or any post-op visit.
Conclusion: Compared to radial head arthroplasty, patients undergoing radial head ORIF had higher pre-op, 6 month, and 12 month PROMIS PF scores but equivocal scores at 2 weeks, 6 weeks, and 12 weeks. The ORIF group also had a significantly higher overall net increase in PROMIS PF scores. In spite of small differences in scores between cohorts, both groups have low levels of function and high levels of PI, indicating these can be life changing injuries and return to preinjury level is unlikely. Alternatively, PROMIS may not be the appropriate outcome to use following radial head fractures.
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