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Long-Term Outcomes of Isolated Stable Radial Head Fractures (JBJS 2014)

Screenshot-2015-05-20-00.12.34-e1432095302195-73x98 Long-Term Outcomes of Isolated Stable Radial Head Fractures (JBJS 2014) Journal Club Upper Extremity | JC


Background

  • Concern for long term results of non-op Mason type I and II fx’s, good short and mid-term results but no good long term data

Design

  • Inclusion: Skeletally mature, >15yo, isolated Mason I or II radial head fx, non-op management
  • Exclusion: Mason type III, concomitant ipsilateral elbow fx, elbow fx/dislocation, associated elbow/forearm instability, lost to f/u
  • Same tx protocol
    • Immobilization w/ cuff and collar w/ early active ROM
    • PT if persistent functional deficit or elbow stiffness
    • PT usually begun at 6wks for ROM and strengthening
  • Pts followed until satisfactory outcome with function and XR assessment
  • Long term f/u by telephone
    • Primary measures: OES and DASH questionnaires
    • Secondary measures: Stiffness, instability, pain, satisfaction, return to work/sports, any surgeries

Results

  • 142 eligible pts, 100 responded (59 female, 41 male)
  • mean of 10yrs post injury
  • females significantly older (52 v 38) and more falls from standing height (86% v 44%)
  • males significantly more sports related injury (44% v 3%)
  • 92% satisfaction overall
  • median return to work 2wks, sports 6wks
  • 14 pts with stiffness, 2pts underwent additional surgery
  • Worse DASH score significantly assoc w/:
    • Increasing age, one or more comorbidities, increasing socioeconomic deprivation, increasing fx displacement, workers compensation pts
  • Trend toward significance b/w worse DASH score and fx displacement ≥ 4mm
  • No significant difference in secondary outcome measures b/w Mason I v II, radial head v neck

Discussion

  • Conservative management yields good

    long term

    results
  • Most common complaint is elbow stiffness (14% in this study)
  • Only clear indication for surgery for Mason II is mechanical block to forearm rotation
    • Displacement ≥ 2mm not an indication
  • fx displacement ≥ 4mm may be an indicaton for surgery but study underpowered to prove that
  • 1st study to demonstrate deprivation assoc w/ worse outcome
    • possible contributing factors: comorbidities, EtOH, smoking, nutrition, exercise, education, compliance, access to health care, life expectancy (none of these were individually examined)

Strengths

  • long f/u, large # of patients, all x-rays available, inclusion of socioeconomic status

Weaknesses

retrospective, 30% lost to f/u, not really standard tx protocol as some got PT sooner than others

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