Radial head fractures: Loss of cortical contact is associated with concomitant fracture or dislocation

Hypothesis

Among radial head fractures displaced greater than 2 mm (Broberg and Morrey modified Mason type 2), separation (complete loss of cortical contact) of at least 1 radial head fracture fragment is associated with a complex injury pattern, meaning that there are other concomitant elbow fractures or ligament injuries.

Materials and methods

We identified 291 consecutive skeletally mature patients with 296 radial head fractures treated during a 6-year period. Of these, 121 consecutive fractures of part of the radial head displaced greater than 2 mm (type 2) were classified according to whether there was complete lack of cortical contact between a fracture fragment and the rest of the proximal radius. Predictors of isolated vs complex injury pattern were sought in bivariate and multivariable analyses.

Results

Of 121 fractures, 30 (25%) were classified as having cortical contact, and 91 (75%) were classified as not having cortical contact. Ten (33%) with cortical contact were part of a complex elbow injury, and 83 of 91 fractures (91%) without cortical contact were part of a complex elbow injury (P < .01). Among the Mason type 2 fractures, loss of cortical contact was a significant predictor of a complex elbow injury in both bivariate and multivariable analyses, with an odds ratio of 21 (95% confidence interval, 7-59).

Conclusions

Among Mason type 2 fractures, complete loss of cortical contact of at least one fracture fragment is strongly predictive of a complex injury pattern.

Level of evidence

4, Retrospective case series, Treatment study

Keywords: Radial head fracture, dislocation, instability, displacement