Delayed Proximal Migration of the Radius Following Radial Head Resection for Management of a Symptomatic Radial Neck Nonunion Managed with Radial Head Replacement: A Case Report and Review of the Literature.

BACKGROUND: Long-term outcomes of radial head resection for radial head fracture have shown mixed outcomes, depending on the integrity of the soft-tissue stabilizers of the elbow, forearm, and wrist.

METHODS: We report a case of a symptomatic delayed proximal migration of the radius after radial head excision for radial neck nonunion which was managed with a staged radial head replacement. Informed consent was obtained from the individual in this case report.

RESULTS: At 7 months after radial head replacement, the patient had 90 degrees of forearm supination and 85 degrees of pronation. Elbow range of motion was from 10 degrees short of full extension to 155 degrees of flexion. Her Disabilities of the Arm, Shoulder, and Hand score was 21.4 at 7 months and 6.48 at 38 months.

CONCLUSION: There is insufficient evidence to reliably predict which patients can be managed definitively with radial head excision without risk of later proximal migration of the radius. The authors suggest the use of acute radial head arthroplasty when the index injury is secondary to a traumatic mechanism, reserving radial head excision for patients with radio-capitellar arthritis. Further research of the pathology and healing of concomitant soft-tissue injuries seen in conjunction with radial head fractures is warranted to guide their treatment.