[Results of excision of the radial head in comminuted fractures].

Objectives: To evaluate the results of radial head excision in the treatment of comminuted radial head fractures.

Methods: The study included 20 patients (14 men, 6 women; mean age 34 years; range 21 to 55 years) who underwent radial head excision for comminuted, closed fractures. Sixteen patients had Mason type 3 and four patients had type 4 fractures. Surgery was performed at a mean of eight days after trauma (range 1 to 30 days). Patients were assessed with regard to whether they were able to return their former activities and work, and whether they had pain, limitation, loss of strength, and instability. The results were evaluated by the Radin and Riseborough's classification. The mean follow-up period was seven years (range 2 to 12 years).

Results: Sixteen patients (80%) re-gained their previous activities or work. Nine patients became asymptomatic. Five patients complained of loss of strength in the arm. Pain associated with weight bearing was observed in two patients in the wrist and elbow, respectively, and in both in two patients. Two patients had limitation of more than 30 degrees in at least one of extension, flexion, supination, or pronation. Five patients had mediolateral instability. The mean elbow flexion was 125 degrees (range 100 to 140 degrees). Proximal migration of the radius was detected in five patients (1 mm), two patients (3 mm), and in three patients (5 mm). According to the Radin and Riseboroughs classification, nine (45%), seven (35%), and four (20%) patients had good, fair, and poor results, respectively.

Conclusion: Despite its relevance in elbow kinematics, our results seem to justify excision of the radial head in Mason type 3 comminuted radial head fractures where internal fixation presents severe difficulties.