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Mason type II and III radial head fracture in patients older than 65: is there still a place for radial head resection?

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Abstract

Purpose

To evaluate the clinical outcomes of radial head excision for multifragmentary radial head fracture in patients over 65 years old.

Methods

We retrospectively examined 30 patients over 65 years of age treated with radial head excision for comminuted radial head fractures. Patients were evaluated through clinical examinations, administrative questionnaires (DASH—Disabilities of the Arm, Shoulder and Hand; MEPS—Mayo Elbow Performance Score, VAS—Visual Analog Scale) and plain films.

Results

The mean follow-up was 40 months (range 24–72 months); 27 out of 30 patients claimed to be satisfied. The mean DASH score was 13 (range 3–45.8) and mean MEPS was 79 (range 65–97). The radiographic evaluation showed 21 cases of elbow arthritis; only two of them complained about pain. Heterotopic ossification was evident in six cases with functional impairment in only one patient. Six patients with increased ulnar variance had clinical distal radio-ulnar joint instability.

Discussion

Radial head excision has been considered a safe surgical procedure with satisfactory clinical outcomes. Development in biomechanical studies and prosthetic replacement of the radial head question the validity of radial head excision. In current literature, there are neither long-term follow-up studies on radial head prosthesis outcomes nor studies which consider elderly patient samples.

Conclusion

Radial head resection remains a good option when a radial head fracture occurs in elderly patients, taking into account the influence of poor bone quality and comorbidities on the outcome. Radial head excision is not indicated in the presence of associated lesions, because of the risk of residual elbow instability; complications associated with advanced age must be considered and a strict follow-up granted.

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Authors and Affiliations

  1. Orthopaedic Section, Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari “Aldo Moro”, Bari, Italy

    Giuseppe Solarino, Giovanni Vicenti, Massimiliano Carrozzo, Girolamo Picca & Biagio Moretti

  2. Orthopaedic and Trauma Department, University of Foggia, Foggia, Italy

    Antonella Abate

Authors
  1. Giuseppe Solarino
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  2. Giovanni Vicenti
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  3. Antonella Abate
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  4. Massimiliano Carrozzo
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  5. Girolamo Picca
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  6. Biagio Moretti
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Correspondence to Giovanni Vicenti.

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Conflict of interest

No financial or other relationships that might lead to a conflict of interest are present in this article. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Authors, their immediate family and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. No funds were received in support of this study.

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The work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki 1964).

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Informed consent was obtained from all individual participants included in the study.

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Solarino, G., Vicenti, G., Abate, A. et al. Mason type II and III radial head fracture in patients older than 65: is there still a place for radial head resection?. Aging Clin Exp Res 27 (Suppl 1), 77–83 (2015). https://doi.org/10.1007/s40520-015-0425-1

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  • DOI: https://doi.org/10.1007/s40520-015-0425-1

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