Arthroscopic management of Mason type 2 radial head fractures

Abstract

During decennia the treatment of radial head fractures has been controversial. For Mason type II fractures, more recent studies agree that open reduction and internal fixation is the treatment of choice. It restores biomechanical properties, allows an early mobilisation of motion and results in better functional outcome compared with other treatments. In this study, we present the mid-to-long-term results of an arthroscopic technique for reduction and percutaneous fixation. Fourteen patients were available for follow-up with a final assessment performed at an average of 5 years 6 months (range 1 year to 11 years 3 months). Patients were evaluated for pain, motion and radiological findings. The average elbow score (Broberg and Morrey in J Bone Joint Surg Am 68:669-674, 1986) was 97.6 points (range 86-100), corresponding with 3 good and 11 excellent results. Two of the patients with only good results had associated cartilage lesions of the capitellum. Our results show that arthroscopically assisted reduction and internal fixation of type II radial head fractures is a valid technique with consistently good outcome. Although the technique is technically demanding, it allows more precise articular fracture reduction control, as well as better evaluation of associated lesions.

Capitellar Cartilage Injuries Concomitant With Radial Head Fractures

“…We noticed this injury at open reduction of the radial head, and reduction could be achieved after removal of the cartilage fragment. Michels et al 5 reported 14 Mason type II radial head fractures that were managed by arthroscopic reduction and percutaneous fixation. They found an incidence of 14% capitellar cartilage lesions, and these were associated with a less beneficial outcome.…”

“…Concomitant radial head fractures and capitellar cartilage injuries have previously been described. [5][6][7][8][9][10] In 1931, Milch 9 described 2 patients with radial head fractures and osteochondral capitellum injuries and defined the mechanism of injury. In 1988, Ward and Nunley 10 published a review of combined radial head and capitellar injuries.…”

“…The possible additional traumatic pathologic lesions include another fracture, elbow dislocation, ligamentous injury, and articular cartilage lesions. [5][6][7] Concomitant radial head fractures and capitellar cartilage lesions have previously been described, [5][6][7][8][9][10] but the degree of capitellar articular injury that occurs with a radial head fracture is not always fully appreciated.…”

Radial Head Fractures

“…69,70 Rolla et al 70 reported 6 cases with minimum of 12-month follow-up; half of the cases were classified as Mason type II fractures, whereas 2 were type III and one was type IV. All patients in this series returned to their preinjury level of function within 6 months and at 12 months, the Mayo Elbow Performance scores were excellent for 3 and good for 3 patients.…”

“…68 Still, there have been many case series and described techniques for arthroscopic management of these fractures. 69,70 The indications for such treatment are evolving but seem to be most commonly for fractures with a mechanical block to motion, as well as for fractures that are minimally displaced and that are not part of a more complex pattern of injury. Furthermore, Michels et al 69 have proposed that the arthroscopic technique would allow for decreased capsular dissection compared with open techniques, which would allow for increased fragment stability and decreased need for internal fixation.…”