Treatment of fracture of radial head combined with bony instability around the elbow

Objective To investigate the therapeutic strategies of radial head fracture combined with bony instability around the elbow. Methods From January 2003 to June 2011, 31 patients with radial head fracture combined with bony instability around the elbow were treated. They were 21 males and 10 females, from 20 to 65 years of age (average, 42.6 years). Ulnar coronoid process fracture was found in 11 patients, ulnar olecranon fracture in 14 and capitellum fracture in 6. The radial head fracture was Mason type Ⅱ in 13 patients and Mason type Ⅲ in 18. All patients with radial head fracture were treated with mini-plate or screws. The 3 cases of ulnar coronoid process fracture of typeⅠ received conservative treatment when there was no displaced fracture fragment, or surgery after removal of the fragments in the joint and suture of the capsule. The 7 cases of type Ⅱand type Ⅲ fractures received internal fixation with Kirschner wire or micro-plate after the anterior bundle of the ulnar collateral ligaments (UCL) were repaired. Bone and ligament reconstructions were necessary to rebuild elbow stability in one patient with type Ⅳ fracture. For the ulna olecranon fractures, Kirschner wire with tensile band was used in non-comminuted ones, or plate and screw fixation and bone graft in the 6 comminuted ones. The 6 cases of type I capitellum fracture were treated with compression screw fixation. Results All wounds healed at the primary stage. All fractures united after 3 to 6 months (average, 5.1 months). All the patients were followed up for 18 to 36 months (average, 24.3 months). Traumatic osteoarthritis occurred in 3 cases, and mild heterotopic ossification in 4. The mean range of motion (ROM) of the affected elbow joint was 104°, and the ROM of forearm rotation was 118°. According to Broberg & Morrey evaluation system, the elbow function was rated as excellent in 7 patients, good in 15, fair in 6 and poor in 3. The excellent and good rate was 71.0% . Conclusions In order to achieve good functional restoration of the elbow joint, the radial head fractures should be anatomically reduced and internally fixated with mini-plate or screws. Injury to the bony structures around the elbow, such as ulnar coronoid process fracture, ulnar olecranon fracture and capitellum fracture, must be repaired or reconstructed. Key words: Elbow joint; Radius fractures; Joint instability