[Surgical differential therapy of fracture of the radius head]

The different types of radial head fractures require specific and varying methods of treatment. Between 1982 and 1985, follow-up evaluation of 92 out of 110 patients treated for such fractures at our facility could be performed. The most frequently seen fractures: nondisplaced marginal and marginal sector fractures, as well as fractures of the radial neck, for example, can be treated conservatively. Follow-up results of such treatment were mostly good to very good. The minimal depression injury is also well suited for conservative therapy. Opened reduction and internal fixation is indicated only in cases of extreme depression of the radial head. Displaced marginal, marginal sector or neck fractures exhibiting a tilting of more than 20 degrees require osteosynthesis. The limitations of internal fixation are encountered in reconstruction attempts of comminuted radial head fractures. Due to the poor results obtained after such attempts, internal fixation of such injuries cannot be recommended. Comminuted fractures and neck fractures with an extensive comminuted region as well as displacement of the radial neck more than 20 degrees, require resection, if active elbow movement is not to be expected within 3 weeks. If resection of the radial head cannot be avoided, it should be performed within the first 5 weeks post-injury. Results following early resection are markedly better than those achieved with late resection.