Radial Head Fractures: Current Trends in Treatment and Outcomes, A Retrospective Review

Background: Radial head fractures are common elbow fractures in adults, and their treatment algorithm remains controversial. Particularly with displaced Mason III or IV radial head fractures, studies have shown mixed results when comparing outcomes between radial head arthroplasty (RHA) and open reduction internal fixation (ORIF). Although multifactorial, patient characteristics often play a large role in treatment modality. The purpose of this study was to analyze the current trend in the management of radial head fractures, complications, and need for repeat operation among these groups. Materials and Methods: We conducted a retrospective database review using the IBM Truven MarketScan Databases and analyzing all available patients treated for radial head fractures between 2015 to 2020. Patients were grouped by treatment modality, including nonoperative, ORIF, radial head excision (RHE), and RHA. Patient characteristics, complication rates, reoperation rates, and predictive factors for undergoing surgery were assessed. Results: Our search yielded 18,945 cases of radial head fractures that underwent treatment. The majority of patients were managed nonoperatively (16,035), and fewer were treated via ORIF, RHA, and RHE (1,636, 1,174, and 100, respectively). Of these, between 1% and 2.5% of patients in each group underwent revision surgery. Conclusion: We found that patients who undergo RHA or RHE are typically older and have more comorbidities compared to patients who are treated nonoperatively or undergo ORIF. We found no significant difference in reoperation rates based on initial mode of treatment. Male sex, osteoporosis, coronary artery disease, and a displaced fracture are predictive of undergoing surgery for a radial head fracture.