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Open Reduction and Internal Fixation of Radial Head Fractures

March 01, 2020

Contributors: Charles Mitchell Jobin, MD, FAAOS; Cesar David Lopez, BS; Rami Alrabaa

Radial head fractures are common injuries and usually result from a fall onto an outstretched hand. Patients report pain in the lateral aspect of the elbow, radial head tenderness, and limited elbow range of motion, particularly in pronosupination. Surgeons should evaluate for mechanical blocks to motion and rule out any associated injuries. Plain radiographs are obtained to diagnose radial head fractures, and CT may be performed to better characterize the fracture fragments for preoperative planning. Minimally displaced or Mason type I radial head fractures can be managed nonsurgically via a short period of sling immobilization followed by progressive elbow range of motion. Surgical management is indicated for radial head fractures with a mechanical block and substantially displaced fractures. Surgical treatment options include radial head fragment excision, open reduction and internal fixation, and radial head arthroplasty. Open reduction and internal fixation is preferred for the management of Mason type II and type III radial head fractures if reduction is possible, especially in younger patients. However, patients with osteoporosis, poor bone quality, or radial head fractures with many fragments or severe comminution may not be amenable to open reduction and fixation. The goals of open reduction and fixation are adequate reduction and fixation of the fragments to achieve healing and restore function. This video presents relevant literature and demonstrates the surgical technique for open reduction and internal fixation of radial head fractures with the use of cannulated headless compression screws.

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