[Experiences with primary osteosynthesis in radial head fractures].

Displaced fractures of the radial head are indications for early surgery. The resection is unsatisfactorily leading often to an instable elbow in valgus deformity and to painful troubles in the distal radio ulnar joint. Prosthesis implantation has its own problems. Reconstructive surgery is obviously the best solution. 21 internal fixations in 20 patients were performed using small screws (and 2 plates) between 1968 and 1976. The functional and radiological results are excellent in 15 out of 19 controlled patients. 3 patients have a moderate reduction of the mobility, 1 patient a non-union. -We were impressed by 4 operative observations: The fractures and the displacements use to be unexpectedly important. There is usually a periostal bridge between the head fragments and the neck. That is why complete devitalization of the articular fragments is rare. In about half of our cases we found an important avulsion of the humeral articular cartilage. In 8 of 10 cases these avulsions were interposed in the fragments of the radius. Their removal is necessary for the reduction. -These observations should influence the indication for reconstructive surgery in fractures of the radial head.