Arthroplasty Has Surpassed Surgical Fixation for Radial Head Fractures Among ABOS Oral Examination Candidates: A...

Background/Objectives: Radial head arthroplasty (RHA) and open reduction and internal fixation (ORIF) have emerged as predominant methods of surgical management for radial head fractures. The objective of this study was to evaluate national trends in management of radial head fractures among ABOS oral examination candidates and to compare complication rates between RHA and ORIF. Methods: A search of the American Board of Orthopaedic Surgery (ABOS) oral examination database identified radial head fractures treated with RHA or ORIF between 2003 and 2021 in patients 18 years or older. Results: RHA cases increased significantly from 2003-2021 (p < 0.001). Patients undergoing RHA were older (52.4 years vs. 42.9 years, p < 0.001) and predominantly female (60.8% vs. 45.7%, p < 0.001). Medical and surgical complications within 60 days were higher after RHA (2.9% vs. 1.6%, p = 0.012; 24.9% vs. 20.4%, p = 0.001), most commonly stiffness (10.8% vs. 7.1%, p < 0.001), nerve injury (3.3% vs. 2.7%, p = 0.26), and implant failure (3.4% vs. 2.4%, p = 0.064). Non-union or delayed union (0.5% vs. 2.5%, p < 0.001) was significantly higher after ORIF, and fracture (1.1% vs. 0.3%, p = 0.008) was significantly higher after RHA. The highest proportion of RHA to ORIF was performed by surgeons with shoulder and elbow fellowship training (p < 0.001). Conclusions: Among ABOS Candidates, RHA volume surpassed ORIF for radial head fractures in 2010. Surgical complication rates for radial head fractures are high at 60 days follow-up for both procedures. RHA is associated with higher complication rates, especially stiffness; however, similar reoperation and readmission rates suggest that RHA may have been selected for more complex injuries.