Plate or Arthroplasty for complex Mason Type-III Radial Head Fractures? Mid-to-long term results from a blinded...

The surgical treatment of radial head fractures like Mason type III comminuted radial head fractures is challenging and controversial. Whether to use open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) as treatment methods is under constant debate.

We retrospectively analyzed clinical and radiographic mid- to long-term results of 42 patients with a mean follow-up time of 4.56 years (1.92-7.58 years). Patients were grouped according to fragment numbers and the type of intervention performed (3-4 fragments vs. 4+ fragments; ORIF vs. RHA). At the final follow-up, range of motion (ROM), functional rating scores and subjective pain and function levels were documented by a blinded outcome assessor.

Although minor differences in the mean values were detected when comparing the results of the functional scores, ROM and subjective pain and function levels, only the movement in pronation and supination direction yielded statistically better results in the group of 4+-fragments for the RHA compared to ORIF. However, the 33 % rate of required implant removal amongst the ORIF group should be considered.

This study provides evidence that 3- and 4-part Mason type III fractures are prone to plate osteosynthesis. In contrast, greater than 4-part fractures can more reliably be treated by replacement. This leads to a proposed increase in fragment numbers to four, where ORIF most likely leads to good clinical results. However, in patients with 4+ fragment patterns, ORIF did not show statistically significantly worse results concerning the collected clinical values. This study supports the use of the ORIF approach to save the radial head.