Screw Fixation versus Arthroplasty versus Plate Fixation for 3-Part Radial Head Fractures

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 24; no. 1; pp. 57 - 61
• Main Authors: Wu, Pang Hung, Shen, Liang, Chee, Yu Han
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.04.2016; Sage Publications Ltd; SAGE Publishing
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty; Bone Plates; Bone Screws; Classification; Elbow; Elbow Joint - injuries; Elbow Joint - surgery; Female; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fractures; Humans; Injuries; Joint surgery; Ligaments; Male; Middle Aged; Pain; Radius Fractures - surgery; Range of motion; Range of Motion, Articular; Retrospective Studies; Transplants & implants; Treatment Outcome; Young Adult; radius fractures; bone plates; bone screws; fracture fixation, internal
• ISSN: 2309-4990; 1022-5536; 2309-4990
• DOI: 10.1177/230949901602400114

Purpose. To compare the outcome following headless compression screw fixation versus radial head arthroplasty versus plate fixation for 3-part Mason types III or IV radial head fracture. Methods. Records of 25 men and 16 women aged 21 to 80 (mean, 43.3) years who underwent fixation using 2 to 3 2-mm cannulated headless compression screws (n=16), radial head arthroplasty (n=13), or fixation with a 2-mm Synthes plate (n=12) for 3-part Mason types III or IV radial head and neck fracture were reviewed. Treatment option was decided by the surgeon based on the presence of associated injury, neurovascular deficit, and the Mason classification. Bone union, callus formation, and complications (such as heterotopic ossification, malunion, and nonunion) were assessed by an independent registrar or consultant using radiographs. The Mayo Elbow Performance Score and range of motion were assessed by an independent physiotherapist. Results. The median age of the 3 groups were comparable. Associated injuries were most common in patients with arthroplasty, followed by screw fixation and plate fixation (61.5% vs. 50% vs. 33%, p=0.54). The median time to bone union was shorter after screw fixation than plate fixation (55 vs. 86 days, p=0.05). No patient with screw fixation had nonunion, but 4 patients with plate fixation had nonunion. The 3 groups were comparable in terms of the mean Mayo Elbow Performance Score (p=0.56) and the mean range of motion (p=0.45). The complication rate was highest after plate fixation, followed by screw fixation and arthroplasty (50% vs. 18.8% vs. 15.4%, p=0.048). Excluding 20 patients with associated injuries (8 in screw fixation, 8 in arthroplasty, and 4 in plate fixation), the 3 groups were comparable in terms of the median time to bone union (p=0.109), mean Mayo Elbow Performance Score (p=0.260), mean range of motion (p=0.162), and complication rate (p=0.096). Conclusion. Headless compression screw fixation is a viable option for 3-part radial head fracture. It achieves earlier bone union with fewer complications.