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The Journal of Bone and Joint Surgery (American) 86:1925-1930 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Fractures of the Radial Head and Neck Treated with Radial Head Excision

Pär Herbertsson, MD, PhD1, Per Olof Josefsson, MD, PhD1, Ralph Hasserius, MD, PhD1, Jack Besjakov, MD, PhD1, Fredrik Nyqvist, MD, PhD1 and Magnus K. Karlsson, MD, PhD1

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

Investigation performed at the Departments of Orthopaedics and Radiology, Malmö University Hospital, 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.

Background: The reported long-term outcomes of the treatment of radial head and neck fractures with excision of the radial head have been mixed. The purpose of the present study was to evaluate the long-term outcomes of primary or delayed radial head excision for the treatment of these fractures.

Methods: Sixty-one individuals (mean age, forty-four years) with thirty-nine Mason type-II, ten Mason type-III, and twelve Mason type-IV fractures were evaluated subjectively, objectively, and radiographically at a mean of eighteen years (range, eleven to thirty-three years) after treatment. Forty-three fractures were treated with primary radial head excision, and the remaining eighteen were treated with delayed radial head excision at a median of five months (range, one to 238 months) after the injury.

Results: At the time of follow-up, twenty-eight individuals had no symptoms, twenty-seven had occasional elbow pain, and six had daily pain. Four individuals with daily pain had had a Mason type-IV fracture. The range of motion of the formerly injured upper extremities was slightly less than that of the uninjured upper extremities in terms of flexion (139° ± 11° compared with 142° ± 8°), extension (–7° ± 12° compared with –1° ± 6°), and supination (77° ± 20° compared with 85° ± 10°) (all p < 0.01). A higher percentage of formerly injured elbows than uninjured elbows had cysts, sclerosis, and osteophytes (73% compared with 7%; p < 0.001), but none had a reduced joint space. No differences were found between the outcomes for individuals treated with a primary radial head excision and those for individuals treated with a delayed excision.

Conclusions: Following a displaced radial head or neck fracture, excision of the radial head often leads to a good or fair result. We found no differences in outcome between primary and delayed radial head excisions following a Mason type-II, III, or IV fracture. The outcomes are associated with the type of fracture, with Mason type-IV fractures having the worst results, rather than with the timing of the radial head excision (primary or delayed).

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


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