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Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?
Clinics in Shoulder and Elbow 2018;21:234-239
Published online December 1, 2018
© 2018 Korean Shoulder and Elbow Society.

Hee Seok Yang, Jeong Woo Kim, Sung Hyun Lee, Byung Min Yoo

Department of Orthopaedic Surgery, Wonkwang University Hospital, Iksan, Korea
Correspondence to: Jeong Woo Kim
Department of Orthopaedic Surgery, Wonkwang University Hospital, 895 Muwang-ro, Iksan 54538, Korea
Tel: +82-63-859-1360, Fax: +82-63-852-9329, E-mail: serina@wonkwang.ac.kr, ORCID: https://orcid.org/0000-0002-0828-7179
IRB approval: Wonkwang University Hospital (WKUH 2018-01-011).
Received September 7, 2018; Revised October 11, 2018; Accepted October 11, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved <50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation.
Methods: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving <50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. 
Results: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. 
Conclusions: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving <50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.
Keywords : Elbow; Arthroscopy; Radial head