Functional Outcome of Resection versus Reconstruction in Mason II-III Radial Head Fractures; A Short-Term Prospective Study

Abstract

Objective:To compare the short-term functional outcome between resection and reconstruction in Mason Type II and Type III radial head fractures using Broberg and Morrey score. Methods: A prospective cohort study was conducted in the Department of Orthopedic Surgery of SMS Medical College and attached Hospitals. A total of 29 patients (15 in resection group, 14 in reconstruction group) between the age group of 20-60 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. The functional outcome including the range of motion, extension lag and Broberg Morrey score were determined and compared between two groups. Results: The mean age of resection group was 44.5±6.6 years and mean age of reconstruction group was 37.1±6.2 years. The baseline characteristics . At 12-months follow-up, in Mason type II fracture, radial head reconstruction group with mean extension lag of 9.4±4.1 and mean Broberg Morrey score of 94.9±5.1 showed better results compared to radial head resection group with mean extension lag of 15.7±4.1 (p=0.022) and mean Broberg Morrey score of 88.3±5.1 (p=0.045) respectively. In Mason type III fractures, radial head resection with mean supination of 79.4±4.7, mean pronation of 74.4±4.1 and mean Broberg Morrey score of 89.8±6 showed better results when compared with radial head reconstruction group with mean supination of 64.2±4 (p<0.001), mean pronation of 59.2±8.4 (p=0.003) and mean Broberg Morrey score of 81.9±5 (p=0.031). Conclusion:The procedure suggested in Mason type II, is reconstruction of radial head. In Mason type III due to difficulty in achieving anatomical reduction results were not good with reconstruction when compared with resection. We recommend radial head excision in Mason type III fractures where anatomical and stable fixation is not possible.

Comparison of open reduction and internal fixation and radial head resection for treatment of Mason type 2 and 3 fractures in young and active patients: our experience

“…In Mason type 3 fractures, instead, anatomical reconstruction is difficult and functional outcomes are poor compared to RHR. Recently, Meena PK et al proposed reconstruction of radial head in Mason type 2 fractures and RHR in Mason type 3 fractures when anatomical and stable fixation is not possible 19 . There are no long-term studies in the literature demonstrating that RHR increases degeneration at the ulno-humeral joint 20 .…”

Rehabilitation protocol after radial head arthroplasty – a single centre experience and narrative review of the literature

“…The planning of the correct process of surgical and rehabilitation treatment is dictated by the knowledge of the mechanism of injury and the role of damaged anatomical structures in the biomechanics of the elbow joint [4,12,13]. The fractures in the area of the radial bone head occur most often as a result of falling on a bent elbow joint during the abduction of the shoulder or during injuries of the 'crooked mechanism' of the elbow joint [11,14].…”

“…Less often, fractures are caused by direct injuries in this area. Bone trauma is most often accompanied by soft tissue injuries, which include structures such as annular ligament, medial and lateral collateral ligaments, and the joint capsule [3,11,12,15]. in the case of such multi-traumatic injuries, the radial head takes the main stabilizing role in the elbow [11].…”

“…Type i fractures account for about 82% of injuries and are treated conservatively. The indications for surgical treatment are fractures of ii-iV type with the displacement of fragments, limitation of mobility, and elbow instability [1,12,17,18]. Factors that influence the decision to implant a radial head prosthesis include a large number of fractured fragments (more than 3 fragments), the risk of osteonecrosis after osteosynthesis, fracture of the head associated with dislocation within the radial-ulnar joint, and the patient's age (in younger patients, osteosynthesis of the broken head is preferred) [1,8,12,14].…”

“…The dependence of the treatment effects on the implemented rehabilitation process in patients who had undergone radial head arthroplasty is unquestionable [5,12,14]. However, the inconsistency of available rehabilitation protocols allows to presume that conducting randomized trials on the mobility improvement scheme would provide even better Physiotherapy Quarterly (formerly Fizjoterapia) 2018, 26 (1) physiotherapyquarterly.pl knowledge about mobility and functionality regain in the operated joints.…”