Abstract: Purpose: To study the occurrence of posterolateral instability of elbow joint following radial head excision in patients with radial head fracture and to determine the coexisting condition which contributes to instability.
Methods: A retrospective cross sectional study designed to assess the occurrence of posterolateral instability of elbow following radial head excision. 30 patients who had undergone radial head excision for Masons type 2, 3, and 4 fracture between March 2010 to July 2018 were included in the study. On their follow up visit persistent symptom of elbow pain, signs of elbow instability (pivot shift test and chair push up test), mayo elbow score and radiological features were assessed for diagnosing the posterolateral instability of the elbow.
Results: Of the 30 patients evaluated 2 of them had associated ulnar fracture and 1 had elbow dislocation. All 3 complained of pain and discomfort at the elbow joint. Pivot Lateral shift test and chair push up test were positive in these 3 cases, with an average Mayo elbow score of 70 in these 3 patients. The average arc of motion among these 3 patients ranged from 5° to 120° with pronation being 88° and supination of 86° as compared to the ones without instability. Two of the three patients showed radiological features of instability.
Conclusion: Most radial head fractures treated with radial head excision have good outcome clinically, provided it is not associated with any concomitant injury of the elbow and if immobilized properly for minimum of 3 weeks post-surgery to allow for soft tissue healing. A small proportion of patients who have concomitant elbow dislocation or ulna fracture with persistent elbow pain, should undergo further clinical and radiological evaluation in the form of MRI and decision should be taken regarding need for ligament reconstruction or radial head replacement. Hence c existence of elbow dislocation or proximal ulna fracture should be a red flag sign for increased chances of posterolateral instability of the elbow.
