Radial Head Stress Fracture Nonunion in Adolescent Overhead Athletes: A Case Series Original Research

Abstract

Background: While osteochondritis dissecans of the humeral capitellum is well-described in adolescent overhead athletes, lateral compartment overload may also present with isolated radial head involvement. The primary goals of this study are to present a case series of radial head stress fracture nonunions in adolescent athletes and to provide guidelines regarding surgical indications and treatment. We hypothesize that surgical reduction and fixation of symptomatic lesions is safe, effective, and preserves the stability and articular congruity of the radiocapitellar joint.

Methods: We retrospectively reviewed the clinical and radiographic records of nine patients presenting to a pediatric tertiary care center for radial head stress fracture nonunion from January 2008 to December 2016. Patient characteristics, presenting signs and symptoms, clinical and radiographic features, postoperative elbow motion, and radiographic healing were assessed.   

Results: Nine patients (five female; mean age 12.0 years at time of injury) were treated for symptomatic radial head stress fracture nonunion. All patients reported persistent elbow pain with activities of daily living (ADLs) and athletics. Seven patients had limited elbow range of motion. Radiographically, the nonunion fragments comprised 20-45% of the radial head articular surface, and five patients had concomitant radial head subluxation. Five patients underwent open reduction internal fixation, one patient underwent microfracture and debridement, and one patient underwent intraarticular corrective osteotomy. All operative patients had improved or complete resolution of pain with ADLs. Additionally, all operative patients either significantly increased or regained full elbow range of motion. Progressive or complete radiographic healing was seen at a median of 14 weeks postoperatively.

Conclusions: In this case series, skeletally immature athletes with radial head stress fracture nonunions experienced pain relief, maintained or improved motion, and radiographic bony union following surgical intervention. Radiocapitellar joint stability and congruity were preserved or restored.