Comparative Study between Surgical Excision of Radial Head Fracture versus Arthroplasty, A Systematic Review of Literature

Abstract

Radial head fracture is the most frequently diagnosed fracture of the elbow in adults. The radial head is a secondary valgus stabilizer of the joint and it is involved in transmission of axial force load through the elbow during flexion. It is also a varus and external rotatory constraint. Primary goal in surgical treatment is to restore elbow stability in order to preserve the complex physiologic elbow kinematics. These types of fractures are often associated with multiple ligamentous injuries amounting to elbow instability. Radial head resection has been proposed as good option for surgical treatment, while in the last decades, the development of technology and design in radial head prosthesis has increased efficacy in prosthetic replacemen. Many authors have described serious complications in case of resection of the radial head such as proximal migration of radius and longitudinal instability, humeroulnar osteoarthritis, decrease in grip strength, cubitusvalgus, and ulnar neuropathy. Therefore, radial head arthroplasty has obtained a large consensus in orthopedic surgeries as primary option of treatment in fractures Mason types III and IV. It allows an anatomical reconstruction and it maintains stability and physiologic kinematics of the elbow if associated with ligament reconstruction. However, oversizing or overstuffing of radial head prosthesis and malpositioning may lead to a high rate of complications and failure of this surgical procedure. We aimed in this study to compare the functional outcome between Excision of head radius and Arthroplasty in surgical management of radial head fractures (Mason types III and IV) and to assess the complications of both techniques.