Orthopedic Department, Hospital Universitario la Paz, Madrid, SPAIN

Purpose: To review the long-term results of radial head resection after radial head fractures not associated with instability in patients younger than 40 years.

Material and Methods: 26 patients (20 men and 6 women) younger than 40 years (mean age, 28) who sustained an isolated fracture of the radial head (6 type II, 20 type III)and were treated with primary radial head resection were reviewed at a mean follow-up of 24 years. Functional results were evaluated according to the Mayo Elbow Performance Score (MEPS) and the Dash score. Radiographic assessment of osteoarthritic changes and carrying angle were also performed.

Results: 21 patients (80%) had no pain, 3 had mild pain, and 2 had moderate pain. The mean arc of motion was from 9º to 139º. 25 elbows (96%) had a functional arc of motion. They had a mean of 84º of pronation and 84º of supination. 19 elbows had normal strength, 5 had mild loss, and 2 had moderate loss. Mean MEPS was 94 points: satisfactory in 24 elbows (92%) and unsatisfactory in 2 (8%). Dash Score averaged 6 points. In 4 patients, some degree of elbow instability could be detected. The carrying angle was significantly larger than that of the uninjured elbows (20.8º versus 10.4º). Osteoarthritic changes were considered mild in 17 elbows and moderate in 9. We could not detect significant differences is functional outcome based on degree of radiographic osteoarthritic changes.

Conclusion: Radial head resection in young patients with isolated fractures without instability yields long term satisfactory results in over 90% of cases. Osteoarthritic changes are uniformly present but are not related to functional impairment. These results serve as a baseline to which other forms of treatment, such as radial head replacement, could compared in this specific group of patients.