Clinical Scorecard: Outcomes Reported by Patients Following Surgery for Isolated Radial Head Fractures: A Comprehensive Review

At a Glance

Key Highlights

• Radial head fractures are the most common elbow injury, comprising about one-third of elbow injuries.
• Displaced fractures are treated surgically by ORIF, excision arthroplasty, or RHA depending on fracture type and reconstructability.
• Patient-reported outcomes following surgery for isolated radial head fractures have not been systematically evaluated prior to this review.

Guideline-Based Recommendations

Diagnosis

• Classify radial head fractures using modified Mason Type II or III criteria.
• Exclude patients with concomitant ipsilateral injuries for isolated fracture management.

Management

• Non-comminuted fractures: manage with ORIF targeting anatomic reduction and stable fixation.
• Comminuted fractures not amenable to ORIF or excision: consider radial head arthroplasty.
• Radial head excision restores mobility but may not restore stability, especially with ligament injuries.

Monitoring & Follow-up

• Follow-up should be at least one year post-operatively to assess patient-reported outcomes.
• Monitor for complications such as mal-union, non-union, post-traumatic arthritis, avascular necrosis, and tardy ulnar nerve palsy.

Risks

• ORIF in comminuted fractures may result in poor functional outcomes due to mal-union or avascular necrosis.
• Radial head excision may lead to elbow instability and tardy ulnar nerve palsy.
• RHA carries risks of short-term and long-term post-operative complications.

Patient & Prescribing Data

Adults with isolated modified Mason Type II or III radial head fractures undergoing surgical intervention.

Surgical choice depends on fracture comminution and reconstructability; patient-reported outcomes focus on pain, function, and return to work.

Clinical Best Practices

• Use patient-reported outcome measures to evaluate surgical success from the patient’s perspective.
• Exclude patients with concomitant injuries to accurately assess isolated radial head fracture outcomes.
• Ensure multidisciplinary input and systematic literature review to guide treatment decisions.
• Aim for anatomic reduction and stable fixation in ORIF to optimize functional outcomes.
• Consider the stability of the elbow and presence of ligament injuries when selecting surgical modality.

References

• PROSPERO Registration CRD42022321013
• PRISMA 2020 Statement