Minimally Invasive Treatment of Mason Type II Radial Head Fracture by Intramedullary Pinning

Abstract

Objective: To evaluate the outcome of Mason type II radial head fractures treated by intramedullary pinning.

Methods: From May 2013 to March 2017, we respectively reviewed 25 patients affected by Mason type II radial head fractures. A total of 12 patients who met criteria for inclusion and exclusion were collected and analyzed. They were all isolated displaced partial articular radial head fractures and treated with intramedullary pinning using titanium elastic nails (TEN). The patients comprised eight men and four women with the mean age of 40 years (range, 21-58 years). The clinical evaluation included the range of motion (ROM) in the elbow, the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH), the visual analogue scale (VAS) for pain rating, and the Mayo Elbow Performance Score (MEPS). Follow-up radiographs to monitor related complications were evaluated as well.

Results: All patients were followed-up with a mean of 21.8 months (range, 12-28 months). The average range of elbow flexion-extension was barely unaffected in the injured side when compared to the uninjured side (139.08° ± 3.14° vs 140.16° ± 3.01°, P = 0.398) as were pronation of the forearm (86.50° ± 2.75° vs 87.83° ± 2.12°, P = 0.197) and supination of the forearm (87.41° ± 2.53° vs 88.17° ± 1.95°, P = 0.425). The MEPS was 93.75 ± 5.28 points (range, 85-100), the QuickDASH revealed good to excellent results with 2.33 ± 4.56 points (range, 0-14), and the VAS for pain was 0.33 ± 0.78 (range, 0-2). Only two patients had a minor complication with constant affection of the superficial branch of radial nerve.

Conclusion: Intramedullary pinning technique in the treatment of Mason type II radial head fractures is minimally traumatic and effective and represents good to excellent results in adults.

Keywords: Fracture; Intramedullary pinning; Radial head; Titanium elastic nail.

Figure 1

The bent point in the vicinity of radial tuberosity.

Figure 2

Reduction of fragment assisted by percutaneous wire.

Figure 3

(A) Anteroposterior radiograph of a 52 years old man who fell from standing height, suffering a Mason type II radial head fracture (Table 1, Case 1). (B) Anteroposterior radiograph of post‐operation showed a good reduction of displaced articular surface was achieved after TEN insertion. (C) Anteroposterior radiograph showed bone union without secondary displacement at 12 weeks.

Figure 4

(A) Anteroposterior radiograph of a 35 years old man who fell during sports activities, suffering a Mason type II radial head fracture (Table 1, Case 5). (B) Anteroposterior radiograph showed fracture healing without secondary displacement at 9 weeks. (C) Anteroposterior radiograph did not find any degenerative changes at 2 years follow‐up. The patient had a full ROM without elbow pain.