Aims The aim of this study was to evaluate the outcome of complex radial head fractures at mid-term follow-up, and determine whether open reduction and internal fixation (ORIF) or radial head arthroplasty (RHA) should be recommended for surgical treatment. Methods Patients who underwent surgery for complex radial head fractures (Mason type III, ≥ three fragments) were divided into two groups (ORIF and RHA) and propensity score matching was used to individually match patients based on patient characteristics. Ultimately, 84 patients were included in this study. After a mean follow-up of 4.1 years (2.0 to 9.5), patients were invited for clinical and radiological assessment. The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score were evaluated. Results Patients treated with ORIF showed significantly better postoperative range of motion for flexion and extension (121.1° (SD 16.4°) vs 108.1° (SD 25.8°); p = 0.018). Postoperative functional scores also showed significantly better results in the ORIF group (MEPS 90.1 (SD 13.6) vs 78 (SD 20.5); p = 0.004). There was no significant difference between the groups in terms of the complication rate (RHA 23.8% (n = 10) vs ORIF 26.2% (n = 11)). Implant-related complications occurred in six cases (14.3%) in the RHA group and in five cases (11.9%) in the ORIF group. Conclusion Irrespective of the patient's age, sex, type of injury, or number of fracture fragments, ORIF of the radial head should be attempted initially, if a stable reconstruction can be achieved, as it seems to provide a superior postoperative outcome for the patient compared to primary RHA. If reconstruction is not feasible, RHA is still a viable alternative. In the surgical treatment of complex radial head fractures, reconstruction shows superior postoperative outcomes compared to RHA. Good postoperative results can be achieved even after failed reconstruction and conversion to secondary RHA. Therefore, we encourage surgeons to favour reconstruction of complex radial head fractures, regardless of injury type or number of fragments, as long as a stable fixation can be achieved.

中文翻译：

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复杂桡骨头骨折的手术治疗结果。


目的 本研究的目的是评估中期随访中复杂桡骨头骨折的结局，并确定是否应推荐切开复位内固定术 （ORIF） 或桡骨头关节置换术 （RHA） 进行手术治疗。方法 将接受复杂桡骨头骨折手术的患者 （Mason III 型，≥ 3 个碎片） 分为 ORIF 和 RHA 两组，采用倾向评分匹配，根据患者特征进行个体匹配。最终，本研究纳入了 84 例患者。平均随访 4.1 年 （2.0 至 9.5 年） 后，患者被邀请进行临床和放射学评估。评估梅奥肘部表现评分 （MEPS） 、牛津肘部评分 （OES） 和手臂、肩部和手部残疾 （DASH） 问卷评分。结果 接受 ORIF 治疗的患者术后屈伸运动范围 （121.1° （SD 16.4°） vs 108.1° （SD 25.8°）;p = 0.018）。ORIF 组的术后功能评分也显示结果显著更好 （MEPS 90.1 （SD 13.6） vs 78 （SD 20.5）;p = 0.004）。两组之间在并发症发生率方面无显著差异 （RHA 23.8% （n = 10） vs ORIF 26.2% （n = 11））。RHA 组发生种植体相关并发症 6 例 （14.3%），ORIF 组发生 5 例 （11.9%）。结论 无论患者的年龄、性别、损伤类型或骨折碎片数量如何，如果可以实现稳定的重建，应首先尝试桡骨头的 ORIF，因为与原发性 RHA 相比，它似乎为患者提供了更好的术后结局。如果重建不可行，RHA 仍然是一个可行的替代方案。 在复杂桡骨头骨折的手术治疗中，与 RHA 相比，重建显示出更好的术后结果。即使在重建失败并转化为继发性 RHA 后，也可以获得良好的术后结果。因此，我们鼓励外科医生支持重建复杂的桡骨头骨折，无论损伤类型或碎片数量如何，只要能够实现稳定的固定。