Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation

Koichi Yano; Makoto Fukuda; Takuya Uemura; Yasunori Kaneshiro; Kiyotaka Yamanaka; Hidetoshi Teraura; Ken Yamamoto; Ryo Sasaki; Takeshi Matsuura

doi:10.1007/s43465-022-00792-4

Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation

Indian J Orthop. 2022 Dec 13;57(2):253-261. doi: 10.1007/s43465-022-00792-4. eCollection 2023 Feb.

Authors

Koichi Yano¹, Makoto Fukuda², Takuya Uemura³, Yasunori Kaneshiro¹, Kiyotaka Yamanaka⁴, Hidetoshi Teraura⁵, Ken Yamamoto⁶, Ryo Sasaki¹, Takeshi Matsuura¹

Affiliations

¹ Department of Orthopaedic Surgery, Seikeikai Hospital, 1-1-1 Minamiyasuicho, Sakai-Ku, Sakai City, Osaka 590-0064 Japan.
² Department of Orthopaedic Surgery, Baba Memorial Hospital, 4-244 Hamaderahunaocho, Nishi-Ku, Sakai City, Osaka 592-8341 Japan.
³ Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzakicho, Abeno-Ku, Osaka, 545-0053 Japan.
⁴ Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-Ku, Osaka, 534-0021 Japan.
⁵ Department of Orthopaedic Surgery, Higashisumiyoshi Morimoto Hospital, 3-2-66 Takaai, Higashisumiyoshi-Ku, Osaka, 546-0014 Japan.
⁶ Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, 18-28 Yayoicho, Higashiosaka City, Osaka 579-8026 Japan.

Abstract

Background: We surgically treated comminuted radial head and neck fractures using headless compression screws, including multiple screws for the radial head and a single oblique screw for the radial neck. This study aimed to compare the clinical and radiological results for comminuted radial head and neck fractures between surgery using headless compression screws with a single oblique screw for the radial neck, our new procedure, and a plate system precontoured to the proximal radius.

Methods: This retrospective study included 23 patients (11 and 12 in the screw and plate groups, respectively). The fractures were type 3 according to the Mason-Johnston classification modified by Broberg and Morrey. Clinical outcomes analyzed included the motion range of the elbow and forearm, Mayo Elbow Performance Score, and radiological assessments. In addition, postoperative complications were also investigated. The average follow-up was 18 months.

Results: The bone union was achieved in all the patients, and there were no significant differences in clinical outcomes and radiological assessments except forearm supination (p = 0.02). Furthermore, additional surgical procedures were performed in one and five patients in the screw and plate groups, respectively (p = 0.16). Posterior nerve palsy was observed in two patients in the plate group. Complications were observed in one and six patients in the screw and plate groups, respectively (p = 0.07).

Conclusion: Both surgical procedures achieved good clinical and radiological outcomes with bone and ligament injury repair. The screw group had a greater range of forearm supination than the plate group.

Keywords: Comminuted fracture; Headless compression screw; Open reduction and internal fixation; Plate; Radial head fracture; Radial neck fracture.

© Indian Orthopaedics Association 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.