Intra-articular Radial Head Fractures In the Skeletally Immature Patient

Intra-articular (IARH) and extra-articular (EARH) radial head fractures in skeletally immature patients are uncommon injuries that have not been well studied. The aim of this study was to investigate the rate of complications related to IARH fractures relative to EARH fractures in pediatric patients treated at a tertiary referral children’s hospital. With IRB approval, Current-Procedural Terminology codes were used to identify all patients who underwent management of radial head and/or neck fractures between 2005 and 2012. A retrospective chart review was used to collect variables related to: demographics, fracture type, treatment method(s), complications, need for physical/occupational therapy, and the necessity of subsequent surgery. Mid-P exact tests and logistic regression analyses were used to compare differences in the incidence of complications, need for physical therapy (PT), and need for revision surgery between the IARH and EARH fracture groups. Out of the 311 patients included in the cohort, 12 (3.86%) were affected by IARH fractures and 299 (96.14%) were affected by EARH fractures. The mean age at the time of injury was 11.46 (±3.09) years and 8.32 (±3.31) years in the IARH and EARH group, respectively. The estimated incidence of complications was significantly (P<0.0001) higher in the IARH group (50 per 100) compared with the EARH group (1.34 per 100). A significantly (P<0.0001) larger proportion of the subjects with IARH fractures also needed revision surgery (25% IARH vs. 0% EARH) and PT (50% IARH vs. 19.59% EARH).

The study found that in comparison to EARH fractures, IARH fractures were associated with a significantly greater frequency of complications, higher need for PT, and greater need for surgical intervention. The significant complication rate associated with pediatric IARH fractures makes necessary a greater awareness of this fracture pattern and prompt, aggressive diagnostic and treatment modalities.