The controversy surrounding the treatment of radial-head fractures is based, we feel, on the failure to separate undisplaced, displaced, comminuted, complicated, and pediatric fractures. Considering only isolated injuries in adults and each type of fracture separately, we have personally re-examined eighty-eight patients treated at the Massachusetts General Hospital from 1950 to 1962.
Our major findings were: (1) early motion may displace otherwise undisplaced fractures; (2) if more than one-third of the radial head is displaced, limitation of motion will probably result; (3) the range of motion depends on the anatomical result; (4) inferior radio-ulnar subluxation does occur, but is of so little significance that it can be ignored as an argument against excision of the radial head when this procedure is indicated.
We would treat undisplaced fractures involving less than one-third of the radial head with active motion as soon as the patient is comfortable. We have had no experience in treating undisplaced fractures involving more than one-third of the radial head by immobilizing the elbow until displacement by active motion is no longer possible, but such a procedure might improve the results.
Displaced fractures involving less than two-thirds of the radial head should, we think, be treated by early active motion, started when the patient is comfortable. Displaced fractures involving more than two-thirds of the radial head should be treated by early total excision, as should all comminutcd fractures.
Copyright 1966 by The Journal of Bone and Joint Surgery, Incorporated