Long-term Outcomes after Primary Radial Head Resection Arthroplasty vs. Acute Radial Head Resection vs. Secondary Prosthetic Removal in Comminuted Radial Head Fractures

Background: Aim of this study was to compare the clinical and radiological long-term outcomes following operativetreatment of comminuted radial head fractures using 1) primary radial head resection arthroplasty, 2) acute radial headresection, or 3) necessary secondary prosthetic removal. Additionally, we evaluated complex radial head fracturescombined with elbow dislocation and verified the hypothesis of whether primary radial head resection arthroplasty couldcontribute to ligament healing.Methods: In a comparative retrospective cohort study between 2004 and 2014, 87 (33 female, 54 male) patients withcomminuted radial head fractures with a median age of 45 (range 18-77) years were included and followed-up clinicallyand radiologically. Functional results were evaluated according to MEPS, DASH, Broberg and Morrey, and VAS scores.Results: After a median range of 46 months postoperatively, 48 patients (group 1) obtained an acute radial headresection arthroplasty (MEPS: 70 points, Broberg and Morrey: 63 points, DASH: 34 points, VAS: 3.3 points). Twentypatients (group 2) were treated by radial head resection (MEPS: 63 points, Broberg and Morrey: 50 points, DASH: 49points, VAS 4.2 points) and 19 patients (group 3) needed secondary prosthesis removal (MEPS: 73 points, Brobergand Morrey: 66 points, DASH: 38 points, VAS: 2.8 points). The overall outcome demonstrated a trend towards betterresults and the Kellgren-Lawrence grade of postoperative osteoarthritis was significantly better in groups 1 and 3compared to group 2 (P=0.02).Conclusion: Clinical and radiological long-term results of this study demonstrate a trend towards a better outcomeafter acute radial head resection arthroplasty compared to primary radial head resection, especially in complex fracturesassociated with elbow dislocation. Furthermore, our results encourage the use of primary radial head replacement incases of comminuted non-reconstructable radial head fractures.Level of evidence: III