Review Question - QID 7816

In a young patient, the treatment of choice is open reduction and internal fixation; in patients with a nonreconstructible radial head, metallic replacement can be performed. Fractures of the radial head are classified by Mason into type I, II, and III. Type I fractures are nondisplaced, and can be treated with a sling and early motion. Type II fractures are fractures of a single piece with greater than 2 mm of displacement, and can be treated with a sling and motion if they are not associated with instability or mechanical blocks to motion. Type III fractures are comminuted, displaced fractures. The fracture shown in the figures is a type III fracture with less than three fragments. Fractures with greater than three fragments have been shown to have generally poor outcomes with open reduction and internal fixation; fractures with three or fewer fragments had better results with fewer complications. Silastic replacement has been associated with uniformly poor long-term results. Whereas radial head excision has excellent results in the treatment of radiocapitellar arthritis, it is contraindicated in this patient because he has wrist pain, suggesting an injury to the interosseous membrane (Essex-Lopresti lesion), and radial head excision has a high likelihood of leading to proximal radial migration and distal radioulnar joint instability.