Background: Comminuted fractures of the radial head are challenging
to treat with open reduction and internal fixation. Radial head arthroplasty
is an alternative treatment with results that compare favorably with those
reported after open reduction and internal fixation of similar fractures. The
purpose of this study was to evaluate the two-year outcomes and the rate of
recovery of a closely followed cohort of patients in whom an unreconstructible
radial head fracture had been treated with a modular metallic prosthesis.
Methods: Twenty-six patients (seventeen female and nine male; mean
age, fifty-four years) with an unreconstructible comminuted radial head
fracture and associated elbow injuries were treated with a modular metallic
radial head arthroplasty. Patients who had presented more than four weeks
following the injury or had had the radial head arthroplasty as a second-stage
or salvage procedure were excluded. Of the twenty-six patients, twenty-two had
an associated elbow dislocation, and thirteen of them also had an associated
fracture of the coronoid process. Patients were prospectively followed at
three, six, twelve, and twenty-four months. Self-reported limb function,
general health, range of motion, and isometric strength were assessed by an
Results: Following treatment of the injury, significant decreases in
self-reported and measured impairments were noted over time, with the majority
of the recovery occurring by six months and little further recovery noted
between six and twenty-four months. There were slight-to-moderate deficits in
the range of motion and strength compared with the values on the
contralateral, unaffected side. Patient satisfaction was high at three months
and remained high at two years. All elbow joints remained stable, no implant
required revision, and there was no evidence of overstuffing of the joint.
Mild osteoarthritis was seen in five (19%) of the twenty-six patients.
Conclusions: An arthroplasty with a modular metallic radial head is
a safe and effective option for the treatment of unreconstructible radial head
fractures associated with other elbow injuries. Recovery primarily occurs by
six months, with minimal additional improvements over the next eighteen
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.