Miniplates vs. headless screws for fixation of displaced radial head fractures: a randomized controlled trial

• Published in: Journal of shoulder and elbow surgery 2025-01, Vol.34 (1), p.10-17
• Main Authors: Afifi, Ahmed, Othman, Mustafa, Moharram, Ashraf N., Abdel-Ati, Emad A.
• Format: Article
• Language: English
• Subjects: Adult; Bone Plates; Bone Screws; elbow; Elbow Joint - physiopathology; Elbow Joint - surgery; Female; fixation; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; headless screws; Humans; Male; Middle Aged; miniplates; Prospective Studies; Radial Head and Neck Fractures; Radial head fractures; Radius Fractures - surgery; randomized controlled trial; Range of Motion, Articular; Treatment Outcome; Young Adult
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2024.07.016

Fixation of displaced radial head fractures using miniplates is technically challenging and has some drawbacks like hardware prominence and limitation of forearm rotation. Fixation by headless compression screws has emerged as a less invasive alternative to miniplates. This study compares the radiological and functional outcomes of both methods of fixation. This single-center, prospective, randomized controlled trial was conducted at an academic level 1 trauma center. Sixty patients with displaced isolated radial head fractures were randomized to treatment using either headless compression screws or miniplates in 2 parallel groups. At the final follow-up of 18 months, patients were evaluated radiologically for union and clinically using the Mayo Elbow Performance Score (MEPS), elbow range of motion, grip strength, the visual analogue scale (VAS) for pain, and the Disabilities of the Shoulder, Arm, and Hand (DASH) score. Union was achieved after 8 ± 1.7 weeks in the screw group and after 8.5 ± 2.7 weeks in the plate group. The MEPS was significantly better in the screw group (87.7 ± 10.7) than in the plate group (80.5 ± 13.9). However, this difference is below the minimum clinically important difference (MCID) for the MEPS and as such may not be clinically meaningful. No significant differences were observed between both groups regarding flexion, extension ranges, VAS, grip strength, or the DASH score. However, supination and pronation were significantly better in the screw group. The rate of complications was higher in the plate group (26.7%) than in the screw group (3.3%). Both techniques yielded comparable outcomes with better forearm rotation, a lower complication rate, and a lower hardware removal rate in the screw group.