Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures: A Prospective Cohort Study

Abstract

Objectives: To identify patient-related factors and fracture characteristics influencing the functional outcomes of nonoperatively treated radial head fractures and to determine function at 1 year. Design: Prospective cohort study. Setting: Academic Level 1 trauma center. Patients/Participants: Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016. Intervention: Nonoperative treatment of isolated radial head fractures. Outcome Measurements: Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and range of motion at 1.5–3–6–12 months. Results: One hundred fourteen patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3], and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with, respectively, 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups (P < 0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1 year (P < 0.05). Conclusions: Although most nonoperatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1 year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow for interventions that may optimize function. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.