Clinical Report: Patient-Reported Outcomes After Surgery for Isolated Radial Head Fractures
Overview
This systematic review evaluates patient-reported pain, function, and return to work outcomes following surgical treatment of isolated radial head fractures (Mason II and III). It compares outcomes across open reduction and internal fixation (ORIF), radial head excision, and radial head arthroplasty (RHA), highlighting the lack of consensus on optimal management.
Background
Radial head fractures are the most common elbow injury, often resulting from falls on an outstretched hand, predominantly in middle-aged adults. Treatment options include ORIF, excision arthroplasty, and RHA, each with distinct advantages and complications. The presence of concomitant injuries complicates management and outcomes, but this review focuses exclusively on isolated fractures to better understand patient-centered surgical results. Current evidence-based guidelines for surgical decision-making in these fractures are lacking.
Data Highlights
The review included studies published from 2000 to 2022, focusing on adult patients with isolated Mason II and III radial head fractures undergoing surgical intervention. Patient-reported outcomes were extracted, including pain, function, and return to work metrics, with follow-up periods exceeding one year. Studies reporting only clinical or clinician-assessed outcomes were excluded to emphasize patient perspectives.
Key Findings
ORIF is commonly used for non-comminuted fractures aiming for anatomic reduction and stable fixation.
Comminuted fractures treated with ORIF often have poorer functional outcomes due to complications like mal-union and avascular necrosis.
Radial head excision restores mobility but may compromise elbow stability and risk tardy ulnar nerve palsy, especially with ligamentous injuries.
RHA is reserved for unreconstructable fractures or failed prior treatments but carries risks of short- and long-term complications.
Patient-reported outcomes vary across surgical modalities, with no clear consensus on the optimal approach for isolated radial head fractures.
Concomitant injuries significantly affect outcomes and were excluded to isolate the effect of surgery on isolated fractures.
Clinical Implications
Clinicians should consider the fracture type and patient-specific factors when selecting surgical treatment for isolated radial head fractures. ORIF remains preferred for reconstructable fractures, while RHA or excision may be considered for complex cases, balancing mobility and stability concerns. Patient-reported outcomes should be integrated into decision-making to optimize functional recovery and return to work.
Conclusion
This review underscores the variability in patient-reported outcomes following surgery for isolated radial head fractures and highlights the need for standardized guidelines. Further research focusing on patient-centered metrics is essential to inform optimal surgical management.
