Abstract
Background
Treatment recommendations for isolated radial neck delayed union/nonunion are sparse, but include mainly conservative treatment, electro-stimulation, bone grafting, open reduction and internal fixation (ORIF) and radial head resection. The purpose of this study was to perform a literature review on isolated delayed union/nonunion of radial neck fractures and to evaluate the reported outcomes of proposed treatment strategies. Furthermore, we aimed to generate data-based recommendations for this rare pathology. In the second part of this paper, we report two clinical cases of delayed union of isolated radial neck fractures recently treated at the senior authors institution.
Methods
A literature search on PubMed was performed. We selected all papers with a documented delayed union, pseudarthrosis or nonunion of the radial neck. All papers were reviewed for patient demographics, patient occupation, treatment type and timing relative to the initial trauma, X-ray documentation and outcome. The two patients with delayed union after isolated radial neck fractures recently treated at our institution were evaluated for age, mechanism of injury, occupation, treatment and outcome. Clinical and radiological follow-up examinations were performed 6, 12 weeks, and 1 year after initial trauma. Final clinical evaluations included the Mayo Elbow Performance Score (MEPS) [1] and the Disabilities of the Arm, Shoulder and Hand (DASH) Score [2].
Results
We found 17 cases reported in 11 articles matching our selection criteria of isolated radial neck delayed union or nonunion in adult patients. Average age was 55 years (range 29–73 years). The most frequent mechanism of injury was a fall on an outstretched arm from standing height. Initial treatment consisted of an arm sling for 1–4 weeks and physiotherapy. From the 17 included cases, six were operated on due to persistent pain. Three received bone grafts, one was supplemented with additional K-wire fixation, and three had radial head resections. Ten patients were treated conservatively: six were pain free and three were symptomatic at last follow-up; symptoms were not reported for one case. All surgically treated cases were pain free at the last follow-up, average 32 months (range 6–84). Of the conservatively treated group, eight of ten had documented nonunion. The two reported cases from our institution were initially treated conservatively for 4 and 6 months. Both had a radiologically documented delayed union. Both patients were operated on due to persistent pain precluding them from returning to work. At the last follow-up, MEPS and DASH scores were 100 points and 29 in one case and 100 points and 18 in the other, respectively.
Conclusion
Isolated delayed union or nonunion of the radial neck after conservative treatment in adult patients appears to be rare and often remains asymptomatic. Operative treatment is recommended for symptomatic delayed union/nonunion in patients with altered elbow function [3]. All surgically treated patients in our study with symptomatic delayed unions/nonunions had favorable clinical outcomes.
Similar content being viewed by others
References
Morrey BF, An KN (2009) In: Morrey BF, Sanchez-Soleto (eds) The elbow and its disorders: functional evaluation of the elbow, 4th edn. WB Saunders, Philadelphia, pp 82–92
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med 29:602–608
Ring D, Psychoyios VN, Chin KR, Jupiter JB (2002) Nonunion of nonoperatively treated fractures of the radial head. Clin Orthop Relat Res 398:235–238
Duckworth A, Clement N, Jenkins P (2012) ScienceDirect.com—The Journal of Hand Surgery—The Epidemiology of Radial Head and Neck Fractures. J Hand Surg 37A:112–119
Thomas TT (1907) Fractures of the head and neck of the radius. Ann Surg 46:280–291
Bhandari M, Fong K, Sprague S, Williams D, Petrisor B (2012) Variability in the definition and perceived causes of delayed unions and nonunions. A cross-sectional, multinational survey of orthopaedic surgeons. J Bone Jt Surg 94:e109(1-6)
Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM, LEAP Study Group (2005) Impact of smoking on fracture healing and risk of complications in limb-threatending open tibia fractures. J Orthop Trauma 19:151–157
Sweet FA, Bindra R, Morrey BF, Gelberman RH (1997) The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg Am 79:1653–1662
Ikeda M, Sugiyama K, Kang C, Takagaki T, Oka Y (2005) Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Jt Surg Am 87:76–84. doi:10.2106/JBJS.C.01323
Duckworth AD, McQueen MM, Ring D (2013) Fractures of the radial head. Bone Jt J 95-B:151–159. doi:10.1302/0301-620X.95B2.29877
Cha S-M, Shin H-D, Kim K-C, Song J-H (2013) Non-union of isolated radial neck fracture using a bone graft and temporary K-wire fixation: a case report. Hand Surg 18:389–392. doi:10.1142/S0218810413720210
Neumann MM, Nyffeler RR, Beck MM (2011) Comminuted fractures of the radial head and neck: is fixation to the Shaft necessary? J Bone Jt Surg Br 93:223–228. doi:10.1302/0301-620X.93B2.24760
Li SL, Lu Y, Wang MY (2015) Is cross-screw fixation superior to plate for radial neck fractures? Bone Jt J 97-B:830–835
Gutowski CJ, Darvish K, Ilyas AM, Jones CM (2015) Comparison of crossed screw versus plate fixation for radial neck fractures. Clin Biomech 30:966–970
Smith AM, Morrey BF, Steinmann SP (2007) Low profile fixation of radial head and neck fractures: surgical technique and clinical experience. J Orthop Trauma 10:718–724
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
There is no funding source.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Babst, C., Brunner, A. & Babst, R. Isolated radial neck delayed union/nonunion after conservative treatment in adults: two case reports and a literature review. Arch Orthop Trauma Surg 138, 179–188 (2018). https://doi.org/10.1007/s00402-017-2805-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-017-2805-9