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Surgical Treatment of Radial Head Fractures: Outcomes and Complications.

BACKGROUND
Appropriate treatment of radial head fractures remains an area of disputes and controversy. The present paper aims to assess the outcomes of surgical fixation of these injuries and identify the most common complications.


MATERIAL AND METHODS
The medical records of 63 patients (25 women and 38 men) treated in 2011 -2014 were analysed retrospectively. The treatment outcomes were assessed according to the Broberg and Morrey rating system and the QuickDASH score.


RESULTS
Of 21 patients with isolated fractures, all those with Type 2 fractures demonstrated excellent outcomes. In the group with Type 3 fractures, 11 patients showed satisfactory and 4 unsatisfactory outcomes. Of 19 patients with a fracture combined with elbow dislocation, all those with Type 2 fractures achieved excellent results while in the group with Type 3 fractures 8 patients had satisfactory and 4 had unsatisfactory outcomes. 23 patients were diagnosed with Hotchkiss' terrible triad; 7 of them had sustained Type 2 fractures and showed satisfactory outcomes while those with Type 3 fractures demonstrated 12 satisfactory and 4 unsatisfactory results. Complications included limited elbow mobility (59% of the patients), pain (52.9%), lower muscle strength (35.3%), posttraumatic arthrosis (29.4%), heterotopic ossification (11.8%) and nonunion (1.5%). Eleven patients required repeat surgery.


CONCLUSIONS
1. Today's materials used for the fixation of fracture fragments allow for a stable fixation of almost any fracture of the radial head. 2. As long as fixation of a given radial head fracture is technically possible, open reduction and internal fixation should be attempted. 3. If fixation is impossible, radial head replacement should be a method of choice.