Open reduction and internal fixation compared with excision for unstable displaced fractures of the radial head

Purpose: To determine if excision of the radial head for treatment of an unstable, displaced fracture is associated with a higher rate of early complications or late arthrosis as compared with open reduction and internal fixation (ORIF). Methods: Unstable, displaced fractures of the radial head treated with either excision (15 patients) or ORIF (13 patients) were compared. Implants were removed routinely during the study period. Three patients had instability after radial head excision: 2 were treated in a cast and 1 had temporary pinning of the ulnohumeral joint. Two patients in the ORIF cohort had failure of fixation that subsequently was treated with radial head excision: I had early hardware loosening and 1 developed a nonunion. Results: At the 1-year follow-up evaluation there were no significant differences in the flexion or rotation arc. An average of 17 years after injury there was no significant difference in the flexion arc or rotation arc. One result was rated as unsatisfactory in each cohort according to the Mayo Elbow Performing Index. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 5 points in the ORIF cohort and 15 points in the excision cohort. Eight patients in the excision cohort had arthrosis (5 mild, 2 moderate, 1 severe) compared with 2 patients in the ORIF cohort (I mild, I moderate). Conclusions: Open reduction and internal fixation of an unstable, displaced fracture of the radial head occasionally fails, but it seems to reduce the risk of subsequent elbow dislocation and to protect against long-term arthrosis. (J Hand Surg 2007;32A:630-636. Copyright (C) 2007 by the American Society for Surgery of the Hand.)