[Open reconstruction of radius head fractures with and without accompanying ligament instability. Treatment results]

The treatment of fractures of the radial head is commonly based on the Mason classification. Fractures of the radial head caused by a dislocation of the elbow are summarized as Mason type IV fractures. The purpose of this study was to investigate the outcome and the influence of additional ligamentous injuries after reconstruction of fractures of the radial head.

One hundred three patients with a fracture of the radial head were treated by open reduction and internal fixation between 2004 and 2009. Fifty-eight of them could be evaluated at an average of 3.6 years after surgery. Forty-one patients had no additional ligamentous injury and 17 had a fracture combined with complete dislocation of the elbow. At the final follow-up examination, all patients were assessed clinically, bilateral radiographs were taken, and the Broberg and Morrey and Kellgren & Lawrence scores were determined.

Ten patients had a Mason type II, 31 a Mason type III and 17 a Mason type IV fracture. With regard to the Broberg and Morrey score, patients without ligamentous injury achieved a significantly better functional outcome, with good to excellent results in 97.5% of cases compared to 64.6% for patients with ligamentous injuries. Twelve percent of the patients without ligamentous injury and 47% of the patients with ligamentous injuries developed moderate or severe posttraumatic arthritis. Heterotopic ossification was found in 19.5% of the patients without and in 47% of those with ligamentous injury.

Reconstruction of radial head fractures without ligamentous instability led to significantly superior functional results and lower rates of posttraumatic arthritis and heterotopic ossifications than osteosynthesis of fractures with additional ligamentous injury. In these cases primary endoprosthetic replacement might be considered.