Headless screws for radial head fractures may yield decreased complications vs. miniplates
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Key takeaways:
- Headless screws yielded significantly fewer complications vs. miniplates for radial head fractures.
- However, researchers noted the differences between screw vs. plate fixation may not be clinically relevant.
According to results from a randomized controlled trial of patients with radial head fractures, headless screws yielded better range of motion with fewer complications compared with miniplates, despite similar union rates.
Ahmed Afifi, MD, PhD, from the department of orthopedic surgery at Cairo University in Egypt, and colleagues performed a single-center, prospective, randomized controlled trial of 60 patients who underwent surgery for an isolated radial head fracture between 2020 and 2023.
Afifi and colleagues randomly assigned 30 patients (mean age, 32.8 years) to receive fixation with headless compression screws and 30 patients (mean age, 35.5 years) to receive fixation with miniplates.
Afifi and colleagues evaluated outcomes at a final follow-up of 18 months. Outcomes included union rates on radiographs using the Mayo Elbow Performance Score (MEPS), range of motion, VAS pain scores, grip strength and DASH scores.
Researchers found all patients had successful unions at a mean 8 weeks for the screw group and a mean 8.5 weeks for the plate group. Patients in the screw group returned to daily activities at a mean 10.4 weeks, while patients in the plate group returned to daily activities at a mean 11.8 weeks.
Flexion, VAS pain scores, grip strength and DASH scores were similar between the groups at final follow-up. However, Afifi and colleagues found MEPS was significantly better in the screw group (87.7) compared with the plate group (80.5). Researchers also noted patients in the screw group had improved supination and pronation, as well as a decreased overall complication rate (3.3% vs. 26.7%), compared with patients in the plate group.
“These advantages of screw fixation could allow easier rehabilitation with earlier return to activities as proved by this study,” Afifi and colleagues wrote in the study.
“While the MEPS was statistically better in the screw group, the difference was below the [minimal clinically important difference] MCID for the MEPS, and as such it is not certain that the two treatments are different clinically,” they concluded.
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