Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

Abstract

Background: The use of bone graft for the radial head fractures has been previously described and occasionally used by other authors.This is the first paper, to my knowledge, dealing with the relevant issue about the importance that the use of an autologous bone graft can have on the radial head fractures.

Methods: From July 2010 to July 2014, 20 consecutive patients who underwent open reduction and internal fixation for a closed Mason type II radial head fracture were retrospectively reviewed. Patients with Mason type I, III, simple type II, and comminuted type II fractures treated without bone grafting were excluded. A clinical examination and radiographic evaluation were performed. The overall functional result was evaluated using the Mayo Elbow Performance Score (MEPS). The Broberg and Morrey classification was used to evaluate traumatic arthritis.

Results: The average follow-up duration was 31 months (range, 24-50 months). Bone union of the radial head fracture was achieved in all patients at an average of 13.5 weeks (range, 12-17 weeks). Postoperative radiographs showed no cases of postsurgical ligamentous instability, necrosis of the radial head, or internal fixation failure. The mean range of motion of the affected elbow was 128° ± 8.4° in flexion, 14.5° ± 11.1° in extension, 68.7° ± 14.1° in pronation, and 65.2° ± 18.2° in supination. The mean MEPS was 92 ± 7.9 points (range, 80-100); the outcome was excellent (90-100 points) in 13 patients and good (75-89 points) in 7 patients. The MEPS tended to be higher in patients with an isolated fracture (p = 0.016). Based on the Broberg and Morrey classification for radiographic assessment of post-traumatic arthritis, 15 elbows had no evidence of degenerative changes (grade 0), and 5 elbows had grade 1 changes.

Conclusion: Although radial head fractures may not be amenable to internal fixation, our findings suggest that open reduction and internal fixation with an autogenous bone graft from the lateral epicondyle of the humerus provides satisfactory elbow function in patients with comminuted Mason type II radial head fractures.

Keywords: Elbow; Internal fixation; Radial head fracture.

Fig. 1

Mason type II fractures of radial head include simple (a) and comminuted (b) partial articular fractures with displacement

Fig. 2

A typical case. A 59-year-old man sustained a terrible triad elbow injury and was treated though a lateral approach combined with a medial approach (Case 9). Open reduction and internal fixation with a bone graft for the radial head fracture and repair of the lateral collateral ligament as well as fixation of the coronoid fracture and repair of the medial collateral ligament were performed. a, b Preoperative CT scans showed a comminuted Mason type II radial head fracture and a coronoid fracture. c, d Postoperative radiographs at the last follow-up demonstrated good bone union. The donor site could be seen on the anteroposterior radiograph of the elbow (red arrow)