Marjolein A M Mulders1, Niels W L Schep2, Robert-Jan O de Muinck Keizer3, Izaäk F Kodde4, Jochem M Hoogendoorn5, J Carel Goslings6, Denise Eygendaal7. 1. Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: m.a.mulders@amsterdamumc.nl. 2. Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, the Netherlands. 3. Trauma Unit, Department of Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands. 4. Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Deventer Hospital, Deventer, the Netherlands. 5. Department of Surgery, Haaglanden Medical Center, the Hague, the Netherlands. 6. Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands. 7. Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Department of Orthopedic Surgery, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
Abstract
BACKGROUND: The optimal treatment of isolated displaced partial articular radial head fractures remains controversial. The aim of this randomized controlled trial was to compare the functional outcome of operative treatment with nonoperative treatment in adults with an isolated Mason type 2 radial head fractures. METHODS: In this multicenter randomized controlled trial, patients from 18 years of age with an isolated partial articular fracture of the radial head were randomly assigned to operative treatment by means of open reduction and screw fixation or nonoperative treatment with a pressure bandage. The primary outcome was function assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Questionnaires and clinical follow-up was conducted at admission and at 3, 6, and 12 months. RESULTS: In total, 45 patients were randomized, 23 patients to open reduction and screw fixation and 22 patients to nonoperative treatment with a pressure bandage. At 3, 6, and 12 months, patients treated operatively had similar functional outcomes compared to patients treated nonoperatively (DASH score at 12 months: 0.0 [0.0-4.2] vs. 1.7 [0.0-8.5]; P = .076). CONCLUSIONS: Nonoperatively treated adults with an isolated Mason type 2 radial head fracture have similar functional results after 1 year compared with operatively treated patients. In addition, complication rates were low for both operative and nonoperative treatment.
BACKGROUND: The optimal treatment of isolated displaced partial articular radial head fractures remains controversial. The aim of this randomized controlled trial was to compare the functional outcome of operative treatment with nonoperative treatment in adults with an isolated Mason type 2 radial head fractures. METHODS: In this multicenter randomized controlled trial, patients from 18 years of age with an isolated partial articular fracture of the radial head were randomly assigned to operative treatment by means of open reduction and screw fixation or nonoperative treatment with a pressure bandage. The primary outcome was function assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Questionnaires and clinical follow-up was conducted at admission and at 3, 6, and 12 months. RESULTS: In total, 45 patients were randomized, 23 patients to open reduction and screw fixation and 22 patients to nonoperative treatment with a pressure bandage. At 3, 6, and 12 months, patients treated operatively had similar functional outcomes compared to patients treated nonoperatively (DASH score at 12 months: 0.0 [0.0-4.2] vs. 1.7 [0.0-8.5]; P = .076). CONCLUSIONS: Nonoperatively treated adults with an isolated Mason type 2 radial head fracture have similar functional results after 1 year compared with operatively treated patients. In addition, complication rates were low for both operative and nonoperative treatment.