The long-term clinical and radiographic outcomes for smooth stem metallic radial head replacements (RHR) used for acute radial head fractures are currently unknown. Short to medium term outcomes (mean 8 years) have been published on this population cohort (1–3). This is an updated study reporting the long-term clinical and radiographic outcomes. A retrospective review was performed of patients who underwent a smooth stem RHR for acute fractures (< 4 weeks from fracture date) at a single upper extremity referral center. Patients returned for assessment and outcome measures including patient-rated elbow evaluation (PREE), Mayo elbow performance index (MEPI), single assessment numeric evaluation (SANE), disabilities of the arm, shoulder and hand (DASH), short-form 12 (SF-12), physical examination and radiographic evaluation. Elbow and forearm motion and grip strength were measured where possible. Thirty-one patients with 32 RHR participated in the study. The mean follow up was 17±4years. The mean age at injury was 51±13 and at follow up was 69±10. Twenty-two (71%) patients were female. Eight elbows (25%) had an isolated radial head injury with replacement. Conversely 24 (75%) elbows had an associated injury with 7 (32%), 11 (34%), 16 (50%) and 1(3%) having an elbow dislocation, coronoid fracture, lateral collateral ligament repair (LCL) and LCL plus medial collateral ligament repair, respectively. One RHR was excised for infection. The mean PREE score, MEPI, SANE and DASH scores were 10/100, 92/100, 93/100 and 11/100, respectively. Regarding the MEPI score, 19 (59%), 10 (31%) and 3 (9%) elbows had excellent, good and poor results. Mean elbow extension was 8±10°, flexion was 133±10°, pronation was 87±8° and supination was 76±16°. The mean grip strength of the affected side was 91% compared to the unaffected side. The mean pinch strength of the affected side was 95% compared to the unaffected side. Radiographic changes were mild when assessing for osteopenia, ulnohumeral arthritis, periprosthetic lucency and heterotopic ossification. Three patients (9%) had complications. One patient (3%) required surgery with removal of the RHR due to infection. This patient required further surgery for contracture release and ulnar nerve decompression. One patient had delayed ulnar neuropathy and another patient had complex regional pain syndrome, both patient's symptoms resolved without surgery. The long-term outcomes of acute radial head fractures managed with a smooth stem metallic radial head replacement were good to excellent in a high percentage of patients. Patients returned to and maintained high function in terms of PROMs, range of motion, and strength. Complications and post-traumatic arthritis did occur, however, at a low frequency.
Carroll et al. (Wed,) studied this question.