Nonsurgical treatment of Mason type II radial head fractures in athletes. A retrospective study

Arthroscopic Percutaneous Fixation of Mason Type 2 Radial Head Fractures

Background

Management of radial head fractures around the elbow with open techniques can predispose to edema, postoperative pain, and adhesions. The resultant limitation in elbow range of motion negatively affects functional outcomes. Rehabilitation is then rendered a challenge in a joint with proneness to stiffness.

Hypothesis

Arthroscopic percutaneous fixation of Mason type 2 radial head fractures would provide satisfactory radiological and clinical outcomes.

Study Design

Case series; Level of evidence, 4.

Methods

A total of 24 patients diagnosed with isolated Mason type 2 radial head fractures at a single institution between February 1, 2021, and December 31, 2021, received arthroscopic percutaneous fixation by headless screws. Functional evaluation included Mayo Elbow Performance Score and postoperative elbow range of motion measurements. Radiological evaluation was performed using elbow radiographs and computed tomography scans. Patients were evaluated for a minimum of 24 months.

Results

This study included 12 male and 12 female participants with a mean age of 37.29 ± 11.93 years. At the end of the follow-up period (mean, 27.75 months; range, 24-32 months), the mean elbow flexion was 140.17° ± 8.21° and the extension deficit was 4.17° ± 3.81°. The Mayo Elbow Performance Score revealed 21 patients with excellent results and 3 patients with good results. All patients returned to preinjury activities at a mean time of 3.1 months (range, 2-6 months) postoperatively. Union was reached in all patients at a mean time of 7.63 weeks (range, 6-10 weeks). No neurological complications or reoperations were reported at the end of the follow-up period.

Conclusion

Arthroscopic fixation was demonstrated to be a valid and valuable technique for managing isolated Mason type 2 radial head fractures. It allowed for accurate reduction without the need for soft tissue dissection, resulting in excellent clinical outcomes.

Minimally Invasive Treatment of Mason Type II Radial Head Fracture by Intramedullary Pinning

Objective

To evaluate the outcome of Mason type II radial head fractures treated by intramedullary pinning.

Methods

From May 2013 to March 2017, we respectively reviewed 25 patients affected by Mason type II radial head fractures. A total of 12 patients who met criteria for inclusion and exclusion were collected and analyzed. They were all isolated displaced partial articular radial head fractures and treated with intramedullary pinning using titanium elastic nails (TEN). The patients comprised eight men and four women with the mean age of 40 years (range, 21–58 years). The clinical evaluation included the range of motion (ROM) in the elbow, the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH), the visual analogue scale (VAS) for pain rating, and the Mayo Elbow Performance Score (MEPS). Follow‐up radiographs to monitor related complications were evaluated as well.

Results

All patients were followed‐up with a mean of 21.8 months (range, 12–28 months). The average range of elbow flexion‐extension was barely unaffected in the injured side when compared to the uninjured side (139.08° ± 3.14° vs 140.16° ± 3.01°, P = 0.398) as were pronation of the forearm (86.50° ± 2.75° vs 87.83° ± 2.12°, P = 0.197) and supination of the forearm (87.41° ± 2.53° vs 88.17° ± 1.95°, P = 0.425). The MEPS was 93.75 ± 5.28 points (range, 85–100), the QuickDASH revealed good to excellent results with 2.33 ± 4.56 points (range, 0–14), and the VAS for pain was 0.33 ± 0.78 (range, 0–2). Only two patients had a minor complication with constant affection of the superficial branch of radial nerve.

Conclusion

Intramedullary pinning technique in the treatment of Mason type II radial head fractures is minimally traumatic and effective and represents good to excellent results in adults.

[Closed reduction and internal fixation with elastic nail for Mason type radial head fracture in adults]

Objective

To investigate the effectiveness of closed reduction and internal fixation with elastic nails in treatment of Mason type Ⅱ radial head fracture in adults.

Methods

A clinical data of 28 patients with Mason type Ⅱ radial head fractures between May 2013 and March 2017 was retrospectively analyzed. Thirteen patients were treated with closed reduction and internal fixation with elastic nails (trial group); 15 patients were treated with open reduction and internal fixation with Herbert screws (control group). There was no significant difference in gender, age, cause of injury, side of fracture, and the time from injury to operation between the two groups ( P>0.05). The operation time, blood loss, and fluoroscopy times in the two groups were recorded and compared. Postoperative X-ray films were used to evaluate the bone healing, heterotopic ossification, and necrosis of radial head. The effectiveness was evaluated according to Mayo score criteria of the elbow at last follow-up.

Results

All patients were followed up 12-30 months (mean, 21.9 months). The operation time and blood loss were significantly less in the trial group than in the control group ( P<0.05), while the fluoroscopy times significantly increased in the trial group than in the control group ( P<0.05). X-ray films showed that all fractures healed with the bone healing time of (2.85±0.69) months in the trial group and (3.35±0.88) months in the control group. There was no significant difference in bone healing time between the two groups ( t=1.654, P=0.110). Heterotopic ossification occurred in 2 cases in the control group. At last follow-up, there was no significant difference in the Mayo scores between the trial group (90.6±5.3) and the control group (86.4±7.1) ( t=1.750, P=0.092).

Conclusion

Closed reduction and internal fixation with elastic nails, as a minimally invasive technique, has advantages of short operation time and less bleeding in the treatment of Mason type Ⅱ radial head fracture.

Shoulder and Elbow Fractures in Athletes

PURPOSE OF REVIEW

The purposes of this review are to discuss the management of shoulder and elbow fractures in athletes to optimize the return to sport and to highlight treatment impact on the return to play.

RECENT FINDINGS

Fractures of the shoulder and elbow can have profound implications in an athlete career. Recent technique of fractures management trended toward to preserve soft tissue which is critical for an early recovery in athletic population. Arthroscopy presents a strong interest for the treatment of intra-articular fracture, and minimally invasive approach as developed in humeral shaft fracture can be considered to avoid soft tissue damage. Non-articular, stable, and minimally displaced fractures are mainly treated conservatively. However, we encourage a more aggressive approach in shoulder and elbow injuries in the athletes including minimally invasive and stable fixation to preserve vascularity and muscle environment.

Reasons for surgical revision after conservatively treated radial head fractures-retrospective study of 70 patients

Background

An inadequate clinical outcome after conservatively treated radial head fractures is not uncommon. We analyzed the subjective limitations, objective complaints, and surgical procedures for radial head fractures initially treated conservatively.

Patients and method

Between 2007 and 2016, 70 patients (42 men, 28 women) who suffered from fracture sequelae after conservatively treated radial head fractures were examined. Demographic (age, 41.8 years, range, 16–75 years) and clinical data (pain, range of motion, instability) were retrospectively evaluated.

Results

The average time to surgery after trauma was 50 months (range, 5–360 months). In 38 cases, radial head fractures were initially treated with immobilization for 3.4 weeks (range, 1–8 weeks). Physiotherapeutic treatment was performed in 39 cases. In only half of the cases was retrospective Mason classification possible: 20 type I, 8 type II, 5 type III, and 2 type IV. Of the 70 patients, 53 had posttraumatic elbow stiffness; 34 had isolated lateral and four patients isolated medial ligament instability. There were eight cases with a combination of lateral and medial ligament instability and 27 cases of elbow stiffness combined with instability. An average of 1.2 (range, 1–4) surgical procedures per patient were performed. In all, 64 patients underwent elbow arthroscopy with arthrolysis and additional treatment depending on other injuries. The range of motion improved on average from preoperative flexion/extension of 131–15–0° to postoperative flexion/extension of 135–5–0° (gain in flexion: 4.2° and extension: 10.6°).

Conclusion

Conservative treatment of radial head fractures does not always yield good results. Reasons for a poor outcome include chronic instability, cartilage damage, stiffness, or a combination thereof. Improved outcomes can be achieved via arthroscopic arthrolysis.

Results of arthroscopic fixation of Mason type II radial head fractures using Kirschner wires

The goals of this study are to report an arthroscopic technique for the treatment of Mason type II radial head fractures using Kirschner wires (K-wires), and investigate the feasibility and evaluate the results.We retrospectively review 18 cases of closed Mason type II radial head fractures treated in our institution from August 2010 to May 2015. There were 13 males and 5 females with an average age of 30.6 (17-45 years) years. Injuries were caused by falling in 8 cases, by traffic accidents in 5 cases, and by sports in 5 cases. The average time from injury to admission was 3.9 days (1-11 days). All radial head fractures were confirmed on x-ray and computed tomography. The fracture fragments were fixed with percutaneous K-wires under arthroscopy.All surgical wounds healed with primary closure, and no complication occurred, such as neurovascular injury, infection, or hardware failure. All patients were followed up for a mean period of 19 months (range: 14-29 months). Bone union was achieved for all patients with a mean time of 11 weeks. At final follow-up, range of motion of the elbow has no significant difference in comparison to the uninjured side. The mean Visual Analog Scale for these patients was 1.7 (range 0-3). According to the Broberg-Morrey score, there were 7 excellent, 9 good, 2 fair, and 0 poor results (with good or excellent results in 89%). Mayo elbow performance score and the disabilities of the arm, shoulder, and hand score were significantly improved postoperatively.The present study demonstrates that arthroscopic fixation of Mason type II radial head fractures using K-wires provided a stable fixation with good clinical outcomes and patient satisfaction.