Radial head fractures are the most common fractures involving the elbow. They can occur in isolation or in association with other osseous or ligamentous injuries. The management of radial head fractures in the setting of complex elbow instability follows a standardized algorithm. Controversy exists, however, in the management of isolated comminuted unreconstructible radial head fractures, as the options include radial head resection and replacement. Recent literature, expert opinion, and implant manufacturers have focused on the importance of radial head replacement, while radial head resection has been largely overlooked. The paper by Antuña et al. is timely in that it reaffirms the debate that exists with the management of isolated unreconstructible radial head fractures.
Antuña et al. report on the outcome of radial head resection in twenty-six patients after a minimum duration of follow-up of fifteen years. Between 1968 and 1992, thirty-nine patients under the age of forty underwent radial head resection for an isolated fracture at the authors' institution. Twenty-six of these patients were available for clinical and radiographic review at a mean of twenty-five years postoperatively. The outcomes assessed were pain, range of motion, strength, instability, complications, and the results on the Mayo Elbow Performance Scale and the Disabilities of the Arm, Shoulder and Hand Questionnaire.
The authors reported satisfactory outcomes in >90% of their patients. The patients who were unsatisfied had moderate pain, clinical instability, and radiographic evidence of moderate arthritis. The high satisfaction rate reported by the authors is not new information, as several others in the past have reported satisfactory long-term outcomes with radial head resection1-4. The novel parts of this study were that Antuña et al. selected a younger patient cohort for study, as all patients were under the age of forty years at the time of fracture (mean age, twenty-nine years), and that the cohort had a high proportion of manual laborers. Of the sixteen patients who were manual laborers at the time of fracture, thirteen returned to manual work activities without limitations.
The most notable strength of this study is the long-term follow-up of a young patient cohort undergoing radial head resection. The limitations include those that are inherent to a retrospective study, as several patients were lost to follow-up and some preoperative radiographs were unavailable.
The important take-home messages of this retrospective report are that satisfactory sustained outcomes can be expected in the majority of patients undergoing radial head resection for an isolated unreconstructible radial head fracture. In the long-term, the patient's radiographs may demonstrate arthritic changes that will not correlate to functional impairment. The radiographs will also demonstrate an increased carrying angle and radial shortening of approximately 2 to 3 mm. This retrospective study, along with other reports on controversial orthopaedic issues, highlights the need for good randomized prospective studies to definitively answer controversial questions.
*The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
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