Arthroplasty or ORIF: Which is Better for Elbow Fracture?

There is much debate among surgeons about the treatment of elbow fractures. In particular, fractures of the radial head can be difficult to manage. This article addresses those issues and tries to shed some light on the subject.

There are two bones in the forearm that meet at the elbow: the ulna and the radius. The ulna fits into the elbow socket while the radius swivels back and forth against the bottom of the humerus (upper arm).

The top of the radius is called the radial head. The head has a flat top to allow it to glide back and forth as the hand turns palm up and palm down. One-third of all elbow fractures occur at the radial head and neck. In many cases, the injury is caused by a fall on the outstretched hand and arm. The elbow dislocates, and the ligaments around the elbow are torn.

The big question is: should the elbow be repaired or replaced? Elbow joint replacement is called an arthroplasty. Repair is done with an operation called open reduction and internal fixation (ORIF). The authors describe both procedures in detail and discuss when to use each one.

Part of the problem in making this decision is the lack of studies comparing the two operations. And changes in the type of implants and methods used are occurring so fast that results of recent studies reported are already outdated.

The authors suggest that the surgeon must be prepared to make the final decision in the operating room. Fracture pattern and amount of soft tissue damage must be assessed before choosing the best way to stabilize the elbow and restore motion. They prefer the new precontoured implants for ORIF when it can be done easily. Complex injuries require radial head arthroplasty.

Future studies are needed comparing these two treatment options with long-term follow-up before best practice can be determined. Until this information is available, the surgeon must weigh all the factors and make the best decision possible. Keeping up with all the latest changes and techniques is an important part of that process.

References: Nirmal C. Tejwani, MD and Hemang Mehta, MD. Fractures of the Radial Head and Neck: Current Concepts in Management. In Journal of the American Academy of Orthopaedic Surgeons. July 2007. Vol. 15. No. 7. Pp. 380-387.