A SHORT-TERM COMPARATIVE ANALYSIS OF RADIAL HEAD FRACTURES MANAGED USING RADIAL HEAD PLATING VERSUS RADIAL HEAD EXCISION.

Abstract

Introduction: The elbow is a complex joint connecting the upper arm and forearm, consisting of multiple joints, including the radiocapitellar joint. The disc-shaped radial head moves against a round structure on the humerus called the capitellum. This interaction enables movements like turning the palm up (supination) and down (pronation), as well as bending and straightening the elbow. The radial head plays a crucial role in these movements, making it essential for positioning the hand in space. Aims and Objectives: The study aims to compare the functional outcomes of different surgical treatments for radial head fractures, such as radial head plating and excision, focusing on range of motion, functional recovery, and return to pre-injury activities. Materials and Methods: Following institutional board approval and patient consent, a prospective case controlled clinical study was conducted with 30 patients, all classified as ASA physical status 1 and 2. Each patient underwent anterior-posterior and lateral elbow radiographs. Preoperative assessments included range of motion, pain levels, and joint stability. Of the patients, 11 underwent radial head plating, while 19 had radial head excision. Postoperative evaluations were carried out during follow-up visits, assessing range of motion, return to work, and grading using the Mayo Elbow Performance Score (MEPS). Results: Among the 30 patients, MEPS indicated that 18.18% of those treated with radial head plating achieved excellent results, 45.45% good, and 36.36% fair. In the excision group, 36.84% achieved excellent outcomes, while 63.15% had good results. The interval between trauma and surgery was typically 3 to 5 days. Postoperative hospital stays were shorter for patients who underwent radial head excision (2 to 3 days) compared to those with plating (5 to 7 days). The mean time for bone union in the plating group was 8 to 10 weeks, with one case of delayed union taking 12 weeks for radiographic evidence of osseous healing. The average time to return to normal activities was 11 weeks for radial head excision and 13 weeks for radial head plating. Conclusion: Radial head excision has certain advantages over radial head plating, including better stability, strength, and favorable functional outcomes. In this study, patients undergoing excision experienced shorter rehabilitation times compared to those treated with open reduction and internal fixation (ORIF). Excision resulted in a shorter operative time, reduced hospital stay, and quicker rehabilitation. However, ORIF showed superior functional outcomes with fewer complications when adequate fixation was achieved.