Displaced Mason type II fractures of the radial head are often treated non-operatively. However it has been our experience that a number of patients with these injuries have an unsatisfactory result due to a malunion or nonunion of the radial head. The literature however does not address whether it is worthwhile to perform an osteotomy and reduce anatomically established non-unions or mal-unions of the radial head. Our aim was to assess whether operative management of late presenting displaced fractures of the radial head will improve patients pain and function.
Materials and Methods
We retrospectively reviewed thirty-three consecutive patients who presented late to the senior author’s practice between 2001 and 2008 with isolated symptomatic Mason type II fractures of the radial head. Presentation was between 3 weeks and 10 months post injury. All patients had an obvious malunion or established nonunion of the radial head. These patients then underwent an osteotomy, elevation and anatomical reduction, and internal fixation with or without bone grafting to the radial head. We then evaluated these patients for pre and post-operative pain, elbow range of movement, and function.
In this series there was a statistically significant improvement of elbow range of movement and reduction in elbow pain after the surgical procedure. All radiographs showed established union and the deformity or step in the radial head was improved in all cases. 2 cases required a second arthroscopic procedure post internal fixation. All patients had improved function and were glad they had undergone surgery.
Patients often present late following an injury to the radial head. A non-united or malunited articular fracture with a step or gap with a mechanical block can cause a dilemma regarding whether there will be a benefit in operating at a late stage. There have been no studies addressing this in the literature. Our study suggests that osteotomy, elevation and internal fixation of late radial head fractures can improve patients function, range of motion and decrease their overall pain.