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Uncomplicated Mason Type-II and III Fractures of the Radial Head and Neck in Adults

A Long-Term Follow-Up Study

¹ Department of Orthopaedics (P.H., P.-O.J., R.H., C.K., and M.K.) and Department of Radiology (J.B.), University Hospital MAS, SE-205 02 Malmo, Sweden. E-mail address for P. Herbertsson: par.herbertsson{at}skane.se. E-mail address for P.-O. Josefsson: peo.josefsson{at}skane.se. E-mail address for R. Hasserius: ralph.hasserius{at}skane.se. E-mail address for C. Karlsson: caroline.karlsson{at}skane.se. E-mail address for J. Besjakov: jack.besjakov{at}skane.se. E-mail address for M. Karlsson: magnus.karlsson{at}orto.mas.lu.se

Investigation performed at the University Hospital MAS, Malmo, Sweden

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Methods: Seventy women and thirty men who were a mean of forty-seven years old when they sustained a fracture of the radial head or neck (a Mason type-II fracture in seventy-six patients and a Mason type-III fracture in twenty-four) were reexamined after a mean of nineteen years. Radiographic signs of degenerative changes of the elbow were recorded. The fracture had been treated with an elastic bandage or a collar and cuff sling with mobilization for forty-four individuals, with cast immobilization for thirty-four, with resection of the radial head in nineteen, with open reduction of the radial head in two, and with a collateral ligament repair in one. Secondary excision of the radial head was performed because of residual pain in nine patients, and a neurolysis of the ulnar nerve was performed in one patient.

Results: Seventy-seven individuals had no symptoms in the injured elbow at the time of follow-up, twenty-one had occasional pain, and two had daily pain. The injured elbows had a slight flexion deficit compared with the uninjured elbows (mean and standard deviation, 138° ± 8° compared with 140° ± 7°) as well as a small extension deficit (mean and standard deviation, –4° ± 8° compared with –1° ± 6°) (p < 0.001 for both). The prevalence of degenerative changes was higher in the injured elbows than in the uninjured ones (76% compared with 16%, p < 0.001).

Conclusions: The results following uncomplicated Mason type-II and III fractures are predominantly favorable. A secondary radial head resection is usually effective for patients with an unfavorable outcome (predominantly long-standing pain).

Levels of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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