Tratamiento no quirúrgico primario de las fracturas en dos partes …(I)

Thomas Åkesson, Med. Stud.1, Pär Herbertsson, MD, PhD1, Per-Olof Josefsson, MD, PhD1, Ralph Hasserius, MD, PhD1, Jack Besjakov, MD, PhD1 and Magnus K. Karlsson, MD, PhD1

1 Department of Orthopaedics (T.A., P.H., P.-O.J., R.H., and M.K.K.) and Radiology (J.B.), Malmö University Hospital, Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, SE -20502 Malmö, Sweden. E-mail address for M.K. Karlsson: magnus.karlsson@med.lu.se

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Moderately displaced two-fragment fractures of the radial head have been treated predominantly nonoperatively. Recently, however, open reduction and internal fixation has gradually gained interest, without clear evidence that initial nonoperative treatment leads to an unfavorable outcome. As a consequence, the purpose of the present study was to evaluate the long-term outcome after the initial nonoperative treatment of this type of fracture.

Methods: Fifteen men and thirty-four women, with a mean age of forty-nine years at the time of the injury, were included in the study. All patients initially had been managed nonoperatively for a two-fragment fracture of the radial head that was displaced 2 to 5 mm and that included 30% of the joint surface (a Mason type-IIa fracture). Early mobilization had been used for twenty-seven patients, and cast immobilization for a mean of two weeks (range, one to four weeks) had been used for twenty-two. All patients were reevaluated with a questionnaire after a mean of nineteen years, and thirty-four also had a clinical and a radiographic evaluation. Six patients had had a delayed radial head excision because of an unsatisfactory primary outcome.

Results: Forty of the forty-nine patients had no subjective complaints, eight were slightly impaired as the result of occasional elbow pain, and one had daily pain. Flexion was slightly impaired in the injured elbows as compared with the uninjured elbows (137° ± 8° compared with 139° ± 7°), as was extension (–3° ± 7° compared with 1° ± 5°) and supination (86° ± 7° compared with 88° ± 4°) (p < 0.05 for all comparisons). The prevalence of degenerative changes on radiographs was higher for the injured elbows than for the uninjured elbows (82% [twenty-eight of thirty-four] compared with 21% [seven of thirty-four]; p < 0.01).

Conclusions: The initial nonoperative treatment of Mason type-IIa fractures of the radial head that are displaced by 2 to 5 mm is associated with a predominantly favorable outcome, especially if a delayed radial head excision is performed in the few cases in which the early outcome is unsatisfactory.