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Study results support restricted elbow rotation after radial head fracture
Patients introduced to active elbow rotation in the early post-traumatic period developed significant range of motion deficits.
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NEW ORLEANS — Findings from a large study of patients with Mason type I or II radial head fractures showed a treatment protocol that limited elbow motion to active flexion and extension after 48 hours immobilization was associated with minimal pain and an acceptable nonunion rate at 2 years follow-up.
Nikolaos K. Paschos, MD, PhD, of Davis, Calif., USA, who presented the results at the American Academy of Orthopaedic Surgeons Annual Meeting, said he and his colleagues theorized that loads transmitted during post-treatment motion, particularly elbow rotation, could play a role in clinical outcomes after radial head fracture.
“In the treatment of minimally displaced radial head fractures, active forearm rotation of the elbow should be restricted for the first two weeks, since it increases the risk of complications,” Paschos told Orthopaedics Today Europe.
To study the effects of post-treatment elbow motion further, Paschos and colleagues prospectively and blindly allocated 300 patients with Mason type I or II radial head fractures into two groups. All patients underwent elbow immobilization for the first 48 hours post-treatment, which an earlier study the investigators conducted proved to be beneficial, according to Paschos.
After that one group was allowed to only perform active elbow flexion and extension. The second group could actively pronate and supinate, as well as perform active elbow flexion and extension exercises.
Once patients with conditions that might compromise their fracture healing were excluded, 142 patients remained in the no rotation group and 139 patients remained in the rotation group.
Sling immobilization
At the meeting Paschos reviewed details of the study. All the patients were immobilized in a sling during the first 48 hours. The no rotation group performed only active flexion and extension for the first 15 days after immobilization and then could perform all elbow motion afterwards.
The fracture healing and nonunion rate proved to be an indicator of the outcomes.
Image: Paschos NK
“We saw 94% of the patients achieved fracture healing within the first 3 months. Only 16 patients had nonunion and it was impressive that 14 of them belonged to the rotation group,” Paschos said.
Differences in outcomes noted
When investigators evaluated the patients based on the Broberg-Morrey and American Shoulder and Elbow Surgeons functional scores, the VAS pain score, and grip and pinch strength, they found some differences between the groups.
“For the functional scores, there was a significant difference — better clinical outcome in the group that had no rotation in their elbow for the first 15 days and this also was a trend for less deficit in the range of motion and less pain,” Paschos said.
Measurements the investigators made of fracture fragment displacement showed a higher percentage of fragment displacement in the early rotation group.
“We saw that patients in the no rotation [group] achieved healing approximately 8 days earlier compared to those with elbow rotation,” Paschos said.
“So it seems that rotation was associated with increasing the rate of fragment displacement, increasing the rate and the risk of nonunion and this resulted in worse clinical outcome,” he said. – by Susan M. Rapp
- References:
- Paschos NK. J Orthop Trauma. 2013;doi:10.1097/BOT.0b013e31825cf765.
- Paschos NK. Paper #43. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.
- For more information:
- Nikolaos K. Paschos, MD, PhD, can be reached at University of California-Davis, 1 Shields Ave., Davis, CA 95616, USA; email: npaschos@ucdavis.edu.
Disclosure: Paschos has no relevant financial disclosures.