Radial Head Arthroplasty for Radial Head Fracture Is Associated with a Lower Rate of Reoperation Than Open Reduction Internal Fixation: A Population-Based Cohort Study.

BACKGROUND: The purpose of this study was to (1) describe the longitudinal trends and epidemiology in surgical management of radial head fractures and (2) compare the rate of reoperation of open reduction internal fixation (ORIF) to radial head arthroplasty (RHA) in Ontario, Canada.

METHODS: All patients aged 16 years and older who sustained a radial head fracture between April 1, 2002 and March 31, 2020 were identified using linked provincial health administrative databases from ICES. Patients undergoing ORIF, RHA or radial head excision for a radial head fracture were followed for subsequent reoperation. An unadjusted competing risk survival analysis was performed to tally the cumulative incidence of all-cause revision procedures. Logistic regression models were constructed to identify the patient-, provider- and fracture-related factors associated with reoperation following ORIF and RHA.

RESULTS: A total of 3159 patients underwent surgical management of a radial head fracture during the study period. The majority of patients were female (55.9%). The mean age of patients who underwent ORIF, RHA and excision was 43.9, 51.1, 52.6 years, respectively. The mean (SD) follow-up times were 8.9 (+/- 5.0), 8.4 (+/- 5.0) and 11.0 (+/-5.0) years, respectively. In total, 7.7%, 3.8% and 0.8% experienced reoperation during study follow-up, respectively. At 10 years, the cumulative incidence function (CIF) for ORIF, RHA and excision was 15.8% (95% CI 13.9%-17.7%), 10.4% (95% CI 8.7%-12.3%) and 6.5% (95% CI 4.1%-9.5%), respectively. Gray's test demonstrated a statistically significant difference between groups favouring RHA over ORIF (P < 0.0001). The most frequently performed secondary procedure was removal of hardware (32%). The odds of reoperation among those younger than 40 years of age who had an ORIF increased when surgery was performed overnight (between midnight and 7AM) (P = 0.0008).

CONCLUSION: Radial head arthroplasty was associated with a lower rate of reoperation than ORIF following radial head fractures, irrespective of patient age. Among patients younger than 40 years, overnight ORIF was associated with an increased rate of reoperation. Long-term studies are needed to evaluate the durability of these findings, particularly in younger patients.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort Comparison using Large Database, Treatment Study.