Functional Outcomes and Complications of Radial Head Fractures Treated with Screw-Fixation

Background: We performed a retrospective analysis of all patients that had a radial head fracture treated with screw fixation from February 2008 to April 2016. Indication for operative treatment was partial articular radial head fracture with displacement >2mm, radial head fracture with greater than one fragment, or if there was restricted supination or pronation. We included 23 patients that were radiographically followed-up for a median of 38 weeks. There were 10 Mason II fractures, 5 Mason III fractures and 8 Mason IV fractures. The fractures were treated with bicortical positioning screws without compression, either through a dorsal- or lateral approach. The range of motion was evaluated clinically by the treating physician and we gathered patient-reported outcomes using the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score. We used a Wilcoxon signed-rank test to compare the range of motion in the injured versus the uninjured elbow. A Fisher’s exact test was used to evaluate the influence of fracture characteristics on the incidence of complications and reoperation. To evaluate factors influencing the quick-DASH we used the Mann-Whitney U test.

Results: The median QuickDASH score was 6.8 (IQR4.6-19.3). There were six complications, non-union being the most common (3/23), followed by hardware irritation (2/23) and heterotopic ossification (1/23). There were significantly more complications in patients with more than two fracture fragments (p=0.045). Four patients required reoperation, hardware removal in 3 patients and one patient underwent late radial head resection.

Summary points:

• This study examined treatment of radial head fractures with screw fixation as a viable option for Mason II, III and IV fractures.
• Screw-fixation has a good patient reported outcome but a higher risk for non-union if more than 2 fragments are present.