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Is ORIF Superior to Nonoperative Treatment in Isolated Displaced Partial Articular Fractures of the Radial Head?

  • Symposium: Traumatic Elbow Instability and its Sequelae
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While good results have been reported with both nonoperative and operative treatment of isolated displaced partial radial head fractures, there remains considerable disagreement about the role of surgery in the management of these injuries.

Questions/purposes

We (1) compared isolated displaced partial articular radial head fractures treated nonoperatively with open reduction internal fixation (ORIF) in terms of validated outcomes scores, ROM, and strength; (2) assessed whether there were any predictor variables for outcomes; and (3) compared complications between groups.

Methods

We retrospectively compared patients with isolated partial articular radial head fractures displaced greater than 2 mm but less than 5 mm who received either nonoperative treatment (30 patients) or ORIF (30 patients). We reviewed the nonoperative and ORIF groups at a mean of 3 and 4.5 years, respectively. The nonoperative and ORIF groups were similar except for age (51 ± 17 years versus 39 ± 10 years, respectively) and fracture displacement (2.3 ± 0.3 mm versus 2.8 ± 0.6 mm, respectively). As there were no definitive guidelines on which treatment represented best management, treatment type was decided by the attending surgeon in conjunction with the patient on a case-by-case basis. Patients were evaluated using the Patient-rated Elbow Evaluation (PREE) (primary outcome measure), Mayo Elbow Performance Score (MEPS), QuickDASH, SF-12, clinical examination, and radiographic evaluation (14 and 28 in the nonoperative and ORIF groups, respectively). Elbow ROM was assessed with a goniometer and hand grip strength with calibrated strength testing. We assessed possible predictive variables (age, displacement, energy of injury) for clinical outcome scores and recorded complications.

Results

PREE scores were not different between groups, but the MEPS favored the nonoperative group (93 versus 86; p = 0.012). ROM and grip strength were similar between groups. Younger age was associated with worse outcome, but displacement and energy were not. More complications occurred in the ORIF group (eight cases of mild heterotopic ossification, two cases of hardware failure) than in the nonoperative group (one case of mild heterotopic ossification, one case of complex regional pain syndrome).

Conclusions

No clinical benefit with ORIF could be found compared to nonoperative management of isolated partial articular radial head fractures with displacement of greater than 2 mm but less than 5 mm at short-term followup. A well-designed randomized trial and followup at longer term are required to provide better information about how to treat these common fractures.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Kristie Millman BSc for her invaluable contribution in following up patients and data processing, performed with both cheerful enthusiasm and expertise. We also thank Jeff Pike MD for his contribution in the identification, chart review, examination, and radiographic review of patients involved in this study.

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Authors and Affiliations

  1. Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand

    Albert Yoon MBChB

  2. Roth/McFarlane Hand and Upper Limb Centre, St Joseph’s Health Care London, 268 Grosvenor Street, London, ON, N6A4L6, Canada

    Graham J. W. King MD, MSc & Ruby Grewal MD, MSc

Authors
  1. Albert Yoon MBChB
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  2. Graham J. W. King MD, MSc
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  3. Ruby Grewal MD, MSc
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Corresponding author

Correspondence to Ruby Grewal MD, MSc.

Additional information

One of the authors certifies that he (GJWK), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000, from Wright Medical Technology (Arlington, TN, USA), and an amount of USD 100,001 to USD 1,000,000, from Tornier Inc (Bloomington, MN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Roth/McFarlane Hand and Upper Limb Centre, St Joseph’s Health Care London, London, Ontario, Canada.

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Yoon, A., King, G.J.W. & Grewal, R. Is ORIF Superior to Nonoperative Treatment in Isolated Displaced Partial Articular Fractures of the Radial Head?. Clin Orthop Relat Res 472, 2105–2112 (2014). https://doi.org/10.1007/s11999-014-3541-x

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  • DOI: https://doi.org/10.1007/s11999-014-3541-x

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