Complex radial head and neck fractures treated with modern locking plate fixation

Background: Internal fixation of complex radial head and neck (CRHN) fractures is difficult, and postoperative complications are common. This study evaluated elbow function and patient clinical status after internal fixation of CRHN fractures with modern locking plates. Methods: We included 40 patients with 41 fractures (1 bilateral lesion). In 25 patients (61%), a concomitant injury was found. Patients were an average age of 46 years (range, 22-70 years). The mean follow-up time was 36 months (range, 2-70 months). Postoperative assessments included evaluation of range of motion, functional scores, and radiologic findings. We assessed fracture healing, surgical complications, revision surgery, and the need for metal removal. Results: Of the 34 fractures available for follow-up, 33 (97%) healed well. The mean extension deficit was 6 degrees (range, 0 degrees-30 degrees). The average elbow flexion was 134 degrees (range, 90 degrees-160 degrees), pronation was 70 degrees (range, 30 degrees-90 degrees), and supination was 64 degrees (range, 20 degrees-90 degrees). The Mayo Elbow Performance Score showed a mean of 90 points (range, 65-100 points). We observed no poor results. The mean Disability of Arm, Shoulder and Hand score was 16.5 (range, 2.5-58.3; n = 29). All patients continued activity without daily analgesics. There were 12 (34%) complications. In 11 (32%) patients, the plate was removed. Conclusions: CRHN fractures fixed with modern locking plates and treated as an osseoligamentous lesion exhibited promising midterm results. The new fixation devices represent an improvement in the treatment of this difficult and common fracture while reducing the need for joint replacement or radial head resection. Diagnosis and treatment of concomitant injuries should be emphasized. (C) 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.