Displaced radial head fractures

Summary

Limited evidence from three small retrospective cohort studies provide mixed results for operative treatment by excision of Mason type II, III, and IV radial head fractures compared with open reduction and internal fixation (ORIF) with plates, wires, screws, or silastic replacement. Two recent studies suggest that slightly better functional results may occur with ORIF compared with excision as treatment, but neither study reached statistical significance. One older study that utilized excision of the radial head as an operative treatment reported a better functional outcome compared with silastic replacement but again, results were not statistically significant. Evidence-based conclusions are difficult given the small sample sizes, uneven distribution of patients into treatment groups, differential length of follow-up, potential measurement bias and selection of treatment based on patient presentation. A methodologically rigorous multi-center randomized controlled trial may provide sufficient sample size to effectively compare treatments for displaced radial head fractures.