Percutaneous elevation of radial head fractures without fixation – a promising technique

Abstract

In Mason type II radial head fractures surgical treatment is recommended. A promising technique is percutaneous elevation for depressed monofragmentary articular surface fractures. This study aimed to investigate the radiographic outcome, complication and revision rate following percutaneous radial head reduction without fixation in Mason type II fractures.

A retrospective study was performed between 2016 and 2021. Data on demographics, dislocation in mm based on pre, one week and at least 6 weeks post-operative x-rays as well as complications including revision surgery were noted. In all patients a 2.0mm K-wire was used as metal bone tamps to reduce the fracture under imaging intensifier until no step was identifiable following an immobilization in a backslap for a week. If no secondary dislocation was noted patients were allowed to actively move the elbow. In 36 patients at a mean age of 38.6±10.7years a percutaneous elevation was performed. The mean displacement at time of initial presentation was 2.2±1.1mm on Coyle and on lateral view 1.2±1.0mm. At initial and final follow up (9.3±2.1days, respectively 64.6±180.8days), the fracture gap was reduced with a displacement of 0.2±0.6mm on Coyle view, respectively 0.2±0.5mm, and 0.3±0.5mm, respectively 0.1±0.3mm on lateral view (p<0.005). The mean surgical time was 14.8±12.2minutes and no complication nor secondary fracture dislocation was observed. This study shows that percutaneous closed reduction without fixation in Mason type II fractures is a very effective technique with a short surgical time and no complications if patients are selected correctly.

Level of evidence: Level III, retrospective trial