Results of Acute Excision of the Radial Head in Elbow Radial Head Fracture-Dislocations

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Abstract
Objectives: To evaluate the results of radial head excision for the treatment of elbow fracture-dislocations with an unsalvageable comminuted radial head fracture and no other associated fractures. Design: Retrospective study. Setting: University Hospital. Patients and intervention: Ten elbow fracture-dislocations with a comminuted radial head fracture treated with radial head excision in our institution between 1990 and 1996 and followed a mean of 4.62 years. Main outcome measurements: Clinical results were graded using the Mayo index and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiographs were evaluated for proximal radius migration, elbow angulation, degenerative changes, and ectopic bone. Results: Final clinical results were excellent in four patients, good in five patients, and fair in one patient. Pain was absent in six patients, mild in three patients, and moderate in one patient. Mean flexion arc was 7.5 to 140 degrees, and mean pronation and supination were 85.5 and 83.5 degrees, respectively. Average strength loss was 15 percent. No elbow was unstable. The raw DASH score ranged from 39 to 62 points (normalized values, 0.66 to 15,79 points). On average, the carrying angle increased 5.4 degrees. Degenerative changes were absent in two, Grade I in four, and Grade II in four patients. Ectopic bone, mainly residual fracture fragments, was evident in four patients. Proximal migration of the radius averaged 1.6 millimeters; the two patients with over four millimeters of migration had mild wrist pain. Conclusions: Acute radial head excision for the treatment of elbow fracture-dislocations provides satisfactory short-term clinical results when there are no other associated intraarticular fractures. However, the long-term significance of the early degenerative changes is not known.