[On-Table Reconstruction of Radial Head Fractures]

Fractures of the proximal radius constitute a significant proportion of elbow joint injuries, representing approximately one-third of all such fractures and 75% of proximal forearm fractures. In adults, they account roughly for 4% of all fractures. Treatment of these fractures varies depending on their severity. No uniform guidelines have been published to date for the treatment of severely comminuted fractures.

The study included 16 patients who underwent on-table reconstruction, with a mean age of 49 years. Half of the cases involved Mason type III fractures, while the other half involved Mason type IV fractures. The 2.0mm (1.5mm) LCP system was used for osteosynthesis. Dislocated fragments were treated using the on-table method, i.e., reconstruction on the instrument table. The patients were followed up for 54 months on average. The results were evaluated using the Mayo Elbow Performance Index (MEPI), and X-ray images were assessed (healing, degenerative changes).

According to MEPI, in 6 patients excellent results were achieved, in 5 patients good results were observed, and in 5 patients fair results were reported. No patient showed poor results. The range of motion in the operated elbow was 125-140° for flexion, 0-45° for extension, and the rotation (supination and pronation) was 45-90°. Complications included partial aseptic necrosis in three cases, non-union and implant failure in two cases. No neurological, vascular, or infectious complications were observed. Revision surgery was performed in 10 patients, with the most common reason being simple removal of the material (7 cases). Moreover, in one case the implantation of a cervicocapital endoprosthesis for non-union was performed.

Humeroradial joint reconstruction is particularly important in unstable fractures. In the past, when open reduction and internal fixation (ORIF) were impossible, radial head excision according to Mason was used. This procedure, however, often resulted in subluxation, arthrosis, and persistent pain. The "on-table" reconstruction method for comminuted fractures of the radial head was first described by Businger and is considered a promising alternative with a low risk of head necrosis, which is also confirmed by other published studies. Even though the radial head replacement in comminuted fractures provides excellent short-term outcomes, complications such as humeral erosion, limited range of motion and pain, or the development of degenerative changes in the joint occur in the medium to long term.

The on-table method has proven to be an effective treatment for comminuted fractures of the radial head with good functional outcomes. Considering the risks associated with radial head replacement, preservation surgery should be opted for if the nature of the fracture allows it. Further follow-up should help standardize treatment guidelines for comminuted fractures of the proximal radius to be able to more accurately assess the effectiveness of individual methods.