Authors: Albert Yoon Graham J W King Ruby Grewal
Publish Date: 2014/02/28
Volume: 472, Issue: 7, Pages: 2105-2112
Abstract
We 1 compared isolated displaced partial articular radial head fractures treated nonoperatively with open reduction internal fixation ORIF in terms of validated outcomes scores ROM and strength 2 assessed whether there were any predictor variables for outcomes and 3 compared complications between groupsWe retrospectively compared patients with isolated partial articular radial head fractures displaced greater than 2 mm but less than 5 mm who received either nonoperative treatment 30 patients or ORIF 30 patients We reviewed the nonoperative and ORIF groups at a mean of 3 and 45 years respectively The nonoperative and ORIF groups were similar except for age 51 ± 17 years versus 39 ± 10 years respectively and fracture displacement 23 ± 03 mm versus 28 ± 06 mm respectively As there were no definitive guidelines on which treatment represented best management treatment type was decided by the attending surgeon in conjunction with the patient on a casebycase basis Patients were evaluated using the Patientrated Elbow Evaluation PREE primary outcome measure Mayo Elbow Performance Score MEPS QuickDASH SF12 clinical examination and radiographic evaluation 14 and 28 in the nonoperative and ORIF groups respectively Elbow ROM was assessed with a goniometer and hand grip strength with calibrated strength testing We assessed possible predictive variables age displacement energy of injury for clinical outcome scores and recorded complicationsPREE scores were not different between groups but the MEPS favored the nonoperative group 93 versus 86 p = 0012 ROM and grip strength were similar between groups Younger age was associated with worse outcome but displacement and energy were not More complications occurred in the ORIF group eight cases of mild heterotopic ossification two cases of hardware failure than in the nonoperative group one case of mild heterotopic ossification one case of complex regional pain syndromeNo clinical benefit with ORIF could be found compared to nonoperative management of isolated partial articular radial head fractures with displacement of greater than 2 mm but less than 5 mm at shortterm followup A welldesigned randomized trial and followup at longer term are required to provide better information about how to treat these common fracturesOne of the authors certifies that he GJWK or a member of his or her immediate family has received or may receive payments or benefits during the study period an amount of USD 100001 to USD 1000000 from Wright Medical Technology Arlington TN USA and an amount of USD 100001 to USD 1000000 from Tornier Inc Bloomington MN USAEach author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtainedWe thank Kristie Millman BSc for her invaluable contribution in following up patients and data processing performed with both cheerful enthusiasm and expertise We also thank Jeff Pike MD for his contribution in the identification chart review examination and radiographic review of patients involved in this study
Keywords: