Comparative study of Headless Compression Screws versus Radial head Locking Plate for Comminuted Radial Head and Neck Fractures.

Comparative study of Headless Compression Screws versus Radial head Locking Plate for Comminuted Radial Head and Neck Fractures. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative study of Headless Compression Screws versus Radial head Locking Plate for Comminuted Radial Head and Neck Fractures. Yuliang Fu, Yuan Cao, Zengzhen Cui, Liangyu Bai, Yang Lv This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7209417/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This retrospective study aimed to compare the efficacy of internal fixation using headless compression screws and radial head locking plate for comminuted radial head and neck fractures with no more than 3 displaced fragments. Methods This retrospective study included 84 patients with radial head and neck fractures treated at Peking University Third Hospital between January 2013 and December 2022, with 38 and 46 patients in the headless compression screw (HCS) and radial head locking plate (RLP) groups, respectively. The main outcome was the comparison of complications between the two groups. Demographic data, pre-operative time (POT), operation time (OT), and hospital stay time (HST) were also recorded. The Mayo Elbow Performance Score (MEPS), range of movement of the elbow and forearm, and reasons for re-operation were compared between the two groups. Results All patients were followed up for an average of 66.4 months (range, 20–135 months). One patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. There was no statistically significant difference in the clinical outcomes between the two groups (p > 0.0023). Additionally, the re-operation rate due to symptomatic hardware was significantly higher in the RLP group (28.3%) than that in the HCS group (2.6%, p = 0.002). Conclusion For internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS. Radial head fracture Headless compression screw Plate Open reduction and internal Fixation Figures Figure 1 Figure 2 Figure 3 Background The radial head plays a crucial role in the elbow joint stability because approximately 60% of the longitudinal load on the elbow is transmitted through the radiocapitellar joint. Radial head fractures account for 1.7–5.4% of all fractures, usually caused by indirect trauma[1]. Axial and valgus forces cause the anterolateral radial head to impact the capitellum, leading to fracture[2]. It may lead to elbow instability, stiffness, chronic pain, and other complications if not managed[2]. Therefore, the management of acute radial head fracture is crucial. Mason type Ⅰ fractures, which include a fissure or marginal sector fracture without displacement, can be treated nonoperatively with early mobilization[3,4]. For displaced or comminuted radial head fractures, nonoperative management may result in complications such as elbow stiffness and fracture non-union[5]. Therefore, surgical interventions, such as radial head excision, open reduction and internal fixation (ORIF),and radial head replacement have become the mainstay of treatment for comminuted radial head fractures in recent decades[5–7]. The radial head replacement is mainly suitable for patients with complete articular radial head fractures with more than three displaced fragments[7]. Furthermore, resection may lead to perceived elbow instability in patients compared with ORIF, thus it is more commonly used for elderly people with lower functional requirements[6].For young and middle-aged patients with comminuted radial head and neck fractures with no more than 3 displaced fracture fragments, ORIF is often the first strategy[6]. ORIF methods include screws, plates and Kirschner wires (K-wires). Smith et al[8] proposed that at least two oblique cross-screws should be used to fix radial head and neck fractures. Therefore, more screws are required when radial head fractures are combined with neck fractures, which increases the risk of screw interference and surgical difficulty. Gruszka D et al[9] treated complex radial head neck fractures with locking compression plates, showing a mean MEPS of 90 points with no poor outcomes. Available evidence suggests no consensus on the optimal fixation method, as each fixation has distinct clinical advantages. Current research shows limited clinical comparisons of surgical approaches for radial head neck fractures. Therefore, comparative clinical studies are necessary. Our retrospective cohort study compared radial head locking plates and headless compression screws in treating these injuries. Methods This retrospective study was complied with the principles of the Declaration of Helsinki and approved by the ethics committee of Peking University Third Hospital (Approval Number: IRB00006761-M20250573). Written informed consent was obtained from each participant before commencement. Design and population Between January 2013 to December 2022, 173 patients with fractures of the radial head were surgically and retrospectively evaluated. After verifying the inclusion and exclusion criteria, 84 patients (48.6%) were included (Fig. 1 ). Fracture types and radial head fracture fragments were determined based on the 3-dimensional (3D) reconstruction of elbow joint computed tomography (CT) scans. The main inclusion criteria were: (1)age of 18 to 65 years, (2)acute unilateral closed injury ( 3), (2)open fractures and pathological fractures, (3)elbow dislocations, and any other fracture around the elbow or any other fracture or clinically evident ligament injury elsewhere in the ipsilateral upper limb, (4)concomitant upper limb neurovascular injury affecting post-operative evaluation, and (5)severe osteoporosis and severe elbow osteoarthritis. Surgical strategy Patients were divided into the headless compression screw (HCS) group and the radial head locking plate (RLP) group based on surgeon preference for fixation with either headless compression screws or radial head locking plate. Under ultrasound-guided brachial plexus block anaesthesia, both groups were placed in a horizontal position using tourniquets. The extensor digitorum communis splitting approach or the Kocher approach was used in all patients. The fracture was exposed, and the fracture fragments were examined. After identifying fracture fragments, radial head articular pieces without soft tissue attachments were removed. Fracture reduction was done with clamps or Kirschner wires (K-wires). In cases of completely detached fragments, radial head reconstruction was performed on the surgical table using the “on-table reconstruction” technique[10]. In the HCS group, headless compression screws were placed in an selected position to achieve fragment fixation (Fig. 2 ). Post-reduction stabilisation required: (1) at least one transverse screw per fragment providing interfragmentary compression, and (2) a minimum of two intercrossing screws engaging the radial shaft cortex. All screw heads were recessed 1–2 mm below the subchondral bone margin to prevent articular surface protrusion. In the RLP group, fixation was achieved using a pre-contoured anatomic radial head locking plate with three proximal and two distal multidirectional locking screws. Full forearm rotation was verified intra-operatively to ensure the radial head was within the safe zone. The safe zone referred to the area on the radial head that did not participate in the proximal radioulnar joint[9] (Fig. 3 ). After fixation, stability was verified through passive elbow movement and unrestricted forearm rotation. The wound was irrigated and closed in layers, and post-operative bracing was applied in a neutral position. Postoperative care and Outcome measurement Postoperatively all patients were immobilised using thermoplastic splints while maintaining the 90° flexion functional position of the elbow joint and the forearm in neutral rotation. Discharge required stable vitals, no infection signs. All patients followed a similar rehabilitation protocol. Radiographic evaluation was performed in all patients with anteroposterior and lateral elbow radiographs at 2 weeks, 1, 2, 3, 6, 12 months and the last follow-up postoperatively. X-rays at 2 weeks confirmed implant stability before removing splints and starting range of motion exercises. Weight bearing was not allowed for 4 weeks in all patients. Weight-bearing rehabilitation was gradually escalated based on radiographic evidence of fracture consolidation, while early overloading was strictly avoided. Bone union was defined by a complete fracture line blurred with continuous callus formation and pain-free weight-bearing capacity of the elbow joint. The following parameters were collected from both groups: pre-operative time (POT, time from initial injury to surgery), operation time (OT), and hospital stay time (HST, time from surgery to discharge). The evaluation was conducted by comparing the Mayo Elbow Performance Score (MEPS)[11], range of movement of the elbow and forearm. Post-operative complications and reasons for re-operation were also observed. Clinical outcome evaluation was performed in all patients at the last follow-up using the MEPS and assessing elbow range of movement. The MEPS was classified as excellent (> 90), good (75–89), fair (60–74), and poor (< 60). Post-operative complications and the reasons for secondary surgery were also assessed at the last follow-up. Complications necessitating surgical treatment were considered major complications, while all others were classified as minor. Data Analysis Data were analysed using SPSS 27.0 statistical software (IBM Corp, Armonk, NY, USA). Data are reported as mean ± standard error of the mean unless otherwise noted. The normality of continuous variables was tested using the Shapiro-Wilk test. Parametric tests (two-tailed independent t-tests) were used for normally distributed data; otherwise, the Mann-Whitney U test was applied. Categorical variables were analysed using the chi-square test or Fisher's exact test. To account for multiple comparisons (21 hypothesis tests), adjusted p-values were calculated using the Bonferroni correction .Statistical significance was set at p < 0.0023. Results Group characteristics The mean follow-up period was 66.4 ± 32.4 (range 20–135) months. In total, 84 patients with unilateral radial head and neck fractures were included. The HCS group included 38 patients (15 males and 23 females, mean age 37.8, range 20–64 years), who underwent treatment with the HCS (Fig. 1 ). The RLP group included 46 patients (19 males and 27 females, mean age 37.1, range 20–63 years) who underwent treatment with the RLP (Fig. 2 ). There were no significant differences between the two groups in terms of demographics, radial head fragment number, POT, OT, or HST (Table 1 ). Table 1 Comparison of the patient characteristics of the HCS group and RLP group HCS Group n = 38 RLP Group n = 46 P Value Age(years) 37.8 ± 13.2 37.1 ± 11.6 0.822 Sex (M/F) 15/23 19/27 0.865 Radial Head Fragment number 2/3 24/14 26/20 0.537 Fracture side (R/L) 20/18 22/24 0.661 Dominant side (R/L) 34/4 42/4 0.776 follow-up time (months) 66.8 ± 32.3 66.2 ± 32.8 0.929 POT (days) 4.2 ± 3.2 3.9 ± 2.4 0.858 OT (min) 60.9 ± 27.3 69.3 ± 38.0 0.314 HST(days) 2.4 ± 1.0 2.7 ± 1.6 0.428 POT, preoperation time; OT, operation time; HST, hospital stay time; R, right; L, left; M, male; F, female; HCS, headless compression screw; RLP, radial head locking plate. Table 2 Postoperative follow-up data HCS Group* n = 37 RLP Group* n = 45 P Value Time to union (month) 3.3 ± 2.3 3.4 ± 2.8 0.145 MEPS 97.3 ± 5.6 95.9 ± 6.7 0.394 Range of movement Flexion (°) 129.0(113.0-139.0) 130.0(123.0–135.0) 0.577 Extension (°) 1.0(0–30.0) 3.0(0–35.0) 0.386 Pronation (°) 81.0(67.0–93.0) 82.0(30.0–92.0) 0.205 Supination (°) 79.0(71.0–89.0) 77.0(70.0–87.0) 0.153 *One case of internal fixation failure per group was excluded Data of range of movement represent median and range; HCS, headless compression screw; RLP, radial head locking plate. Table 3 Complications and Reoperation Indications at Final Follow-up HCS Group n = 38 RLP Group n = 46 P Value Total complication 6 (15.8%) 22 (47.8%) 0.002 Minor complication 4 (10.5%) 7 (15.2%) 0.526 Major complication 2 (5.3%) 15 (32.6%) 0.002 Re-operation 2 (5.3%) 15 (32.6%) 0.002 Hardware removal 1 (2.6%) 13 (28.3%) 0.002 Revision surgery 1 (2.6%) 2 (4.4%) 0.673 HCS, headless compression screw; RLP, radial head locking plate. Clinical outcome Based on follow-up evaluations, one patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. Both fixation methods demonstrated favourable functional recovery, with no statistically significant differences in time to union or MEPS. Additionally, there were no significant differences in the range of movement of the elbow joint between the groups, including flexion, extension deficit, and forearm rotation (Table 2 ). Complications In the HCS group, one patient underwent implant removal and radial head replacement at 7 months post-operatively due to non-union. Two cases showed 30° extension deficits with Hastings and Graham type IIA heterotopic ossification (HO), both managed with conservative treatment and physical rehabilitation. Two patients had posterior interosseous nerve injury with extensor digitorum weakness, resolving after conservative care. In one case, the screws was removed at 5 months post-operatively due to hardware irritation from excessive length. In the RLP group, one patient underwent implant removal and radial head replacement at 9 months post-operatively due to non-union. One case had a 35° extension deficit (type IIA HO), two showed pronation limitations (type IIB HO), and all were treated conservatively. One severe case with approximately 43° pronation loss compared to the contralateral side underwent surgical implant removal and soft tissue release. Posterior interosseous nerve (PIN) injury was observed in three patients, presenting as extensor digitorum weakness. Among them, two resolved and one retained grade 4 muscle strength at the final follow-up. 13 cases required plate removal for hardware-related pain or skin irritation and the symptoms disappeared postoperatively. No wound infections were observed in either group during the follow-up period. Though the incidence of minor complications showed no difference between the two groups (10.5% vs. 15.2%, p = 0.526), the HCS group demonstrated markedly lower rates of major complications requiring re-operation than the RLP group (5.3% vs. 32.6%, p = 0.002). Therefore, a statistically significant difference was observed in overall complication rates between the two groups. The predominant indication for re-operation in the RLP group was symptomatic hardware irritation (2.6% vs. 28.3%, p = 0.002), whereas revision surgery, such as movement restriction and implant failure, showed no significant differences between groups (2.6% vs. 2.2%, p = 0.673, Table 3 ). Discussion Radial head fractures represent one of the most common elbow injuries, predominantly caused by indirect axial loading transmitted through the forearm[12]. The classification of radial head fractures has evolved since Mason introduced the original system in 1954, and Hotchkiss revised the classification in 1997[4]. The Mason classification system categorises these fractures into three types (Ⅰ-III) based on displacement severity and articular involvement, guiding treatment and rehabilitation strategies[4]. Conservative management typically achieves favourable outcomes in Mason type I fractures[13]. On the other hand, for Mason type III fractures, especially those that are comminuted and beyond reconstruction, arthroplasty is recommended. Mulders et al[3] have reported that nonoperatively treated adults with an isolated Mason type 2 radial head fracture with fragment displacement less than 2mm and Involving less than 30% of the articular surface had similar functional results after 1 year compared with operatively treated patients. However, for Mason type II with with mechanical obstruction, surgical fixation with implants such as plates and screws is generally required[14, 15]. Furthermore, severe comminuted radial head fractures with more than three fracture fragments are prone to early fixation failure and nonunion during fixation[16]. Therefore, we excluded severe comminuted fractures with more than three fracture fragments. Biomechanical analysis of plate versus screw fixation for radial neck fractures with concomitant two-part radial head fractures demonstrated no statistically significant difference in stiffness under axial compression[17, 18]. Studies by Li et al[19] and Smith et al[8] reported satisfactory outcomes (MEPS score > 90, Broberg and Morrey score good or excellent) with both plate and screw fixation for radial head fractures. The efficacy of plates and screws in the treatment of radial head fractures was compared in the study by Yano et al[20]. The results showed comparable efficacy of plate and screw in the treatment of radial head fractures and demonstrated a higher reoperation rate and complication rate in the RLP group. In our study, both groups achieved similar clinical outcomes, with comparable MEPS exceeding 90 points (p = 0.394) and no statistically significant differences in post-operative range of movement across flexion-extension (p = 0.577) or forearm rotation (p = 0.153–0.386). In our study, the major complication and reoperation rate were lower in the HCS group than in the RLP group. In the RLP group, most patients who underwent secondary surgery did so not because of pain or implant failure, but due to long-term discomfort caused by foreign body friction during forearm movement. The symptoms disappeared after the removal of the internal plant. Radial head locking plates restore native radial head anatomy and enhance neck stability[21]. The radial head was elliptical rather than perfectly round[22]. Additionally, the shape, angle, and curvature of the proximal radius varied greatly[23]. Thus, although anatomically contoured plates fit the radial head as closely as possible, the anatomical variations of the radial head make it difficult for the plates to completely match, which may be one reason for the increased complication rate. Moreover, the fixation area of the plates is limited to a safe zone, and improper placement can cause post-operative elbow joint mobility issues. Previous studies have shown that a larger dissection area during plate placement increases the rate of HO, thereby limiting rotation[8]. Anatomical studies reveal that the PIN lies within 3.8 cm of the radial articular surface[14]. This suggests that the exposure of the distal part of the radial head increases the risk of injury to the posterior interosseous nerve. Using headless compression screws reduces irritation of the internal fixator to the elbow joint and surrounding soft tissues while minimising the stripping of periosteum. Minimal distal soft tissue dissection optimally reduces the risk of PIN injury during surgical exposure. This study had certain limitations. Firstly, it was a retrospective study, and the surgeons were from the same treatment group, which introduced some variability in surgical procedures and fixation method choices. Secondly, when using screws to fix multiple fracture fragments, the possibility of screw interference must be considered, requiring higher surgical skills, which may affect the choice of the fixation method. Thirdly, elbow joint ligament injury was not evaluated in this study. Finally, due to the low incidence of radial head fractures, a considerable timeframe was required to include cases that may affect follow-up assessments. Future multicentre, large-sample prospective cohort studies are required to provide further clinical evidence. Conclusion For internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS. Abbreviations HCS headless compression screw RLP radial head locking plate MEPS Mayo Elbow Performance Score ORIF open reduction and internal fixation 3D 3-dimensional CT computed tomography VAS Visual analogue scale POT pre-operative time OT operation time HST hospital stay time HO heterotopic ossification PIN posterior interosseous nerve. Declarations Ethics approval and consent to participate The study protocol was approved by the ethics committee of Peking University Third Hospital (Approval Number: IRB00006761-M20250573). Informed consent was signed by each enrolled objective. Consent for publication ： Not applicable Availability of data and materials ： The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests : The authors declare that they have no competing interests Funding : This work was supported by Fund progrmas: Beijing Municipal Health Commission(A82509-05) Authors' contributions ： YF, YC, ZC, LB, and YL were all involved with the conception and design of the study, acquisition of data, analysis and interpretation of data, and drafting and revision of the article. All authors read and approved the final manuscript. Acknowledgements : Not applicable. References Klug A, Gramlich Y, Wincheringer D, et al. Epidemiology and Treatment of Radial Head Fractures: A Database Analysis of Over 70,000 Inpatient Cases. J Hand Surg Am 2021; 46;27-35. Thomas TT. XIV. Fractures of the Head and Neck of the Radius. Ann Surg 1907; 46;280-291. Mulders MAM, Schep NWL, de Muinck Keizer RO, et al. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30;1670-1678. Hotchkiss RN. Displaced fractures of the Radial Head: internal fixation or excision? J Am Acad Orthop Surg. 1997;5:1–10. Khawar H, Craxford S, Ollivere B. Radial head fractures. Br J Hosp Med (Lond). 2020;81(4):1-6. Kadam, A., Kadam, Dr. R., Challani, Dr. A., et al. A comparative study of functional outcome of type 2 and 3 radial head fracture treated with radial head excision versus radial head fixation. International Journal of Orthopaedics Sciences 2021; 7(1), 140–142. Kumar P, Jindal K, Rajnish RK, et al. Excision Versus Replacement in Unrepairable Comminuted Fractures of the Radial Head: A Systematic Review of Outcomes and Complications. Indian J Orthop. 2022;56(8):1305-1315. Smith AM, Morrey BF, Steinmann SP. Low profile fixation of radial head and neck fractures: surgical technique and clinical experience. J Orthop Trauma 2007; 21;718-724. Gruszka D, Nowak TE, Tkacz T, et al. Complex radial head and neck fractures treated with modern locking plate fixation. J Shoulder Elbow Surg 2019; 28;1130-1138. Kastenberger T, Kaiser P, Spicher A, et al. Clinical and radiological outcome of Mason-Johnston types III and IV radial head fractures treated by an on-table reconstruction. J Orthop Surg Res 2022; 17;503. Longo UG, Franceschi F, Loppini M, et al. Rating systems for evaluation of the elbow. Br Med Bull 2008; 87;131-161. van Riet RP, van den BekeroV M, van Tongel A, et al. Radial head fractures. Shoulder Elbow 2020; 12;212-223. Yoon A, King GJ, Grewal R. Is ORIF superior to nonoperative treatment in isolated displaced partial articular fractures of the radial head? Clin Orthop Relat Res 2014; 472;2105-2112. Zhao B, Wang H, Diao S, et al. Comparison of operatively and nonoperatively treated isolated mason type II radial head fractures: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19;540. Mannan M, Hamid MA, Shrivastava N, et al. Functional Outcomes of Radial Head Fractures Treated With Open Reduction and Internal Fixation (ORIF). Cureus 2024; 16;e74801. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 2002; 84;1811-1815. Rebgetz PR, Daniele L, Underhill ID, et al Biomechanical study of headless compression screws versus a locking plate in radial head fracture fixation. J Shoulder Elbow Surg 2019; 28;e111-e116. Yin H, Li Y, Zhao G, et al. [Finite element analysis of the stability of Mason type Ⅲ radial head fracture fixed with three cross-bridge headless compression screw and locking plate]. Zhongguo Gu Shang 2024; 37;57-60. Li SL, Lu Y, Wang MY. Is cross-screw fixation superior to plate for radial neck fractures? Bone Joint J 2015; 97-b;830-835. Yano K, Fukuda M, Uemura T et al. Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation. Indian J Orthop 2023; 57;253-261. Swensen SJ, Tyagi V, Uquillas C, et al. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol 2019; 20;15. van Riet RP, Van Glabbeek F, Neale PG, et al. The noncircular shape of the radial head. J Hand Surg Am 2003; 28;972-978. Van Riet RP, Van Glabbeek F, Neale PG, et al. Anatomical considerations of the radius. Clin Anat 2004; 17;564-569. Diliberti T, Botte MJ, Abrams RA. Anatomical considerations regarding the posterior interosseous nerve during posterolateral approaches to the proximal part of the radius. J Bone Joint Surg Am 2000; 82;809-813. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7209417","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498200335,"identity":"a26026d7-8339-4a33-a22f-029432133dcf","order_by":0,"name":"Yuliang Fu","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuliang","middleName":"","lastName":"Fu","suffix":""},{"id":498200336,"identity":"7d099003-c0c6-407b-a51d-1c245e240f02","order_by":1,"name":"Yuan Cao","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Cao","suffix":""},{"id":498200337,"identity":"28fa05e9-378d-46f3-86cc-ee77a18eedbc","order_by":2,"name":"Zengzhen Cui","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zengzhen","middleName":"","lastName":"Cui","suffix":""},{"id":498200338,"identity":"3e666ee7-e3c8-485b-9e03-0c50bf9a3e7b","order_by":3,"name":"Liangyu Bai","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liangyu","middleName":"","lastName":"Bai","suffix":""},{"id":498200339,"identity":"3375e3b6-12f5-41bc-b978-8316f0298dbb","order_by":4,"name":"Yang Lv","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACPgjFJsfPzHzwAVFa2KA6jSXb2ZINSNEil7jhPI+ZAHFaJHIMPxf8MmPcfJjBjIGhxiaaGC3G0jP70pjNDjOkPWA4lpbbQFALzxkDad6eY2xALccNGBsOE6XF+Ddvz38e42bGNgnitLD3mEnz/GCTMGBmZiNWS1uZNW8Dm4HEYTZmgwRi/AKMwc23ef6w1ff3n//44EONDWEtDAwcBgyMbVB2AmHlIMD+gIHhD3FKR8EoGAWjYIQCAJUzNxwa6etiAAAAAElFTkSuQmCC","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Lv","suffix":""}],"badges":[],"createdAt":"2025-07-25 01:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7209417/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7209417/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88897088,"identity":"5d1a7a3a-59fc-493e-be95-828f36027f8d","added_by":"auto","created_at":"2025-08-12 13:11:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44423,"visible":true,"origin":"","legend":"\u003cp\u003eA flow diagram of the research.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7209417/v1/8fb53543f1e8c15bb0d9697b.png"},{"id":88894726,"identity":"1e9fd60f-9c10-4c32-a509-1a80f021c853","added_by":"auto","created_at":"2025-08-12 13:03:35","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":68772,"visible":true,"origin":"","legend":"\u003cp\u003eHeadless Compression Screw fixation: A-C. Pre-operative AP/lateral views and 3D CT reconstruction showing radial head neck fracture with three comminuted fragments; D. Fixation diagram using transverse screw combined with oblique crossed screws; E-F. 1-day post-operative radiographs; G-H. 18-month follow-up radiographs confirming fracture union.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7209417/v1/633201015310936a6de6441e.jpeg"},{"id":88894736,"identity":"f0e99bc4-5fe0-4db6-be25-17c5c3dbdd2a","added_by":"auto","created_at":"2025-08-12 13:03:38","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":60856,"visible":true,"origin":"","legend":"\u003cp\u003eRadial head locking plate fixation: A-C. Pre-operative AP/lateral views and 3D CT reconstruction showing radial head neck fracture with two fragments; D-E. 1-day post-operative radiographs; F-G. 15-month follow-up radiographs confirming fracture union.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7209417/v1/576b08a0490d5274955bd6d5.jpeg"},{"id":91788540,"identity":"ed60045d-ee88-4ff2-a68f-4e9f5536caeb","added_by":"auto","created_at":"2025-09-21 10:08:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":756307,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7209417/v1/62aefe91-fa1e-40ee-bf6f-cc4f4750322a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative study of Headless Compression Screws versus Radial head Locking Plate for Comminuted Radial Head and Neck Fractures.","fulltext":[{"header":"Background","content":"\u003cp\u003eThe radial head plays a crucial role in the elbow joint stability because approximately 60% of the longitudinal load on the elbow is transmitted through the radiocapitellar joint. Radial head fractures account for 1.7–5.4% of all fractures, usually caused by indirect trauma[1]. Axial and valgus forces cause the anterolateral radial head to impact the capitellum, leading to fracture[2]. It may lead to elbow instability, stiffness, chronic pain, and other complications if not managed[2]. Therefore, the management of acute radial head fracture is crucial.\u003c/p\u003e\u003cp\u003eMason type Ⅰ fractures, which include a fissure or marginal sector fracture without displacement, can be treated nonoperatively with early mobilization[3,4]. For displaced or comminuted radial head fractures, nonoperative management may result in complications such as elbow stiffness and fracture non-union[5]. Therefore, surgical interventions, such as radial head excision, open reduction and internal fixation (ORIF),and radial head replacement have become the mainstay of treatment for comminuted radial head fractures in recent decades[5–7]. The radial head replacement is mainly suitable for patients with complete articular radial head fractures with more than three displaced fragments[7]. Furthermore, resection may lead to perceived elbow instability in patients compared with ORIF, thus it is more commonly used for elderly people with lower functional requirements[6].For young and middle-aged patients with comminuted radial head and neck fractures with no more than 3 displaced fracture fragments, ORIF is often the first strategy[6].\u003c/p\u003e\u003cp\u003eORIF methods include screws, plates and Kirschner wires (K-wires). Smith et al[8] proposed that at least two oblique cross-screws should be used to fix radial head and neck fractures. Therefore, more screws are required when radial head fractures are combined with neck fractures, which increases the risk of screw interference and surgical difficulty. Gruszka D et al[9] treated complex radial head neck fractures with locking compression plates, showing a mean MEPS of 90 points with no poor outcomes. Available evidence suggests no consensus on the optimal fixation method, as each fixation has distinct clinical advantages.\u003c/p\u003e\u003cp\u003eCurrent research shows limited clinical comparisons of surgical approaches for radial head neck fractures. Therefore, comparative clinical studies are necessary. Our retrospective cohort study compared radial head locking plates and headless compression screws in treating these injuries.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This retrospective study was complied with the principles of the Declaration of Helsinki and approved by the ethics committee of Peking University Third Hospital (Approval Number: IRB00006761-M20250573). Written informed consent was obtained from each participant before commencement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDesign and population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBetween January 2013 to December 2022, 173 patients with fractures of the radial head were surgically and retrospectively evaluated. After verifying the inclusion and exclusion criteria, 84 patients (48.6%) were included (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Fracture types and radial head fracture fragments were determined based on the 3-dimensional (3D) reconstruction of elbow joint computed tomography (CT) scans.\u003c/p\u003e\u003cp\u003eThe main inclusion criteria were: (1)age of 18 to 65 years, (2)acute unilateral closed injury (\u0026lt; 2 weeks), and (3)radial neck fractures with displaced radial head fragmenting into two or three piece. Exclusion criteria were: (1)severe comminuted fractures (radial head fracture fragments \u0026gt; 3), (2)open fractures and pathological fractures, (3)elbow dislocations, and any other fracture around the elbow or any other fracture or clinically evident ligament injury elsewhere in the ipsilateral upper limb, (4)concomitant upper limb neurovascular injury affecting post-operative evaluation, and (5)severe osteoporosis and severe elbow osteoarthritis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical strategy\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients were divided into the headless compression screw (HCS) group and the radial head locking plate (RLP) group based on surgeon preference for fixation with either headless compression screws or radial head locking plate. Under ultrasound-guided brachial plexus block anaesthesia, both groups were placed in a horizontal position using tourniquets. The extensor digitorum communis splitting approach or the Kocher approach was used in all patients. The fracture was exposed, and the fracture fragments were examined. After identifying fracture fragments, radial head articular pieces without soft tissue attachments were removed. Fracture reduction was done with clamps or Kirschner wires (K-wires). In cases of completely detached fragments, radial head reconstruction was performed on the surgical table using the “on-table reconstruction” technique[10].\u003c/p\u003e\u003cp\u003eIn the HCS group, headless compression screws were placed in an selected position to achieve fragment fixation (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Post-reduction stabilisation required: (1) at least one transverse screw per fragment providing interfragmentary compression, and (2) a minimum of two intercrossing screws engaging the radial shaft cortex. All screw heads were recessed 1–2 mm below the subchondral bone margin to prevent articular surface protrusion.\u003c/p\u003e\u003cp\u003eIn the RLP group, fixation was achieved using a pre-contoured anatomic radial head locking plate with three proximal and two distal multidirectional locking screws. Full forearm rotation was verified intra-operatively to ensure the radial head was within the safe zone. The safe zone referred to the area on the radial head that did not participate in the proximal radioulnar joint[9] (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAfter fixation, stability was verified through passive elbow movement and unrestricted forearm rotation. The wound was irrigated and closed in layers, and post-operative bracing was applied in a neutral position.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePostoperative care and Outcome measurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePostoperatively all patients were immobilised using thermoplastic splints while maintaining the 90° flexion functional position of the elbow joint and the forearm in neutral rotation. Discharge required stable vitals, no infection signs.\u003c/p\u003e\u003cp\u003eAll patients followed a similar rehabilitation protocol. Radiographic evaluation was performed in all patients with anteroposterior and lateral elbow radiographs at 2 weeks, 1, 2, 3, 6, 12 months and the last follow-up postoperatively. X-rays at 2 weeks confirmed implant stability before removing splints and starting range of motion exercises. Weight bearing was not allowed for 4 weeks in all patients. Weight-bearing rehabilitation was gradually escalated based on radiographic evidence of fracture consolidation, while early overloading was strictly avoided. Bone union was defined by a complete fracture line blurred with continuous callus formation and pain-free weight-bearing capacity of the elbow joint.\u003c/p\u003e\u003cp\u003eThe following parameters were collected from both groups: pre-operative time (POT, time from initial injury to surgery), operation time (OT), and hospital stay time (HST, time from surgery to discharge). The evaluation was conducted by comparing the Mayo Elbow Performance Score (MEPS)[11], range of movement of the elbow and forearm. Post-operative complications and reasons for re-operation were also observed.\u003c/p\u003e\u003cp\u003eClinical outcome evaluation was performed in all patients at the last follow-up using the MEPS and assessing elbow range of movement. The MEPS was classified as excellent (\u0026gt; 90), good (75–89), fair (60–74), and poor (\u0026lt; 60).\u003c/p\u003e\u003cp\u003ePost-operative complications and the reasons for secondary surgery were also assessed at the last follow-up. Complications necessitating surgical treatment were considered major complications, while all others were classified as minor.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were analysed using SPSS 27.0 statistical software (IBM Corp, Armonk, NY, USA). Data are reported as mean ± standard error of the mean unless otherwise noted. The normality of continuous variables was tested using the Shapiro-Wilk test. Parametric tests (two-tailed independent t-tests) were used for normally distributed data; otherwise, the Mann-Whitney U test was applied. Categorical variables were analysed using the chi-square test or Fisher's exact test. To account for multiple comparisons (21 hypothesis tests), adjusted p-values were calculated using the Bonferroni correction .Statistical significance was set at p \u0026lt; 0.0023.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eGroup characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe mean follow-up period was 66.4\u0026thinsp;\u0026plusmn;\u0026thinsp;32.4 (range 20\u0026ndash;135) months. In total, 84 patients with unilateral radial head and neck fractures were included. The HCS group included 38 patients (15 males and 23 females, mean age 37.8, range 20\u0026ndash;64 years), who underwent treatment with the HCS (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The RLP group included 46 patients (19 males and 27 females, mean age 37.1, range 20\u0026ndash;63 years) who underwent treatment with the RLP (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There were no significant differences between the two groups in terms of demographics, radial head fragment number, POT, OT, or HST (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the patient characteristics of the HCS group and RLP group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHCS Group\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRLP Group\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.822\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (M/F)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15/23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19/27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.865\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadial Head Fragment number 2/3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24/14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26/20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFracture side (R/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20/18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22/24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.661\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDominant side (R/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34/4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42/4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.776\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efollow-up time (months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66.8\u0026thinsp;\u0026plusmn;\u0026thinsp;32.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;32.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.929\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOT (days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.858\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOT (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;27.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.3\u0026thinsp;\u0026plusmn;\u0026thinsp;38.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHST(days)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.428\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePOT, preoperation time; OT, operation time; HST, hospital stay time; R, right; L, left; M, male; F, female; HCS, headless compression screw; RLP, radial head locking plate.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostoperative follow-up data\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHCS Group*\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;37\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRLP Group*\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;45\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to union (month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMEPS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.394\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRange of movement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlexion (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e129.0(113.0-139.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130.0(123.0\u0026ndash;135.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.577\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtension (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0(0\u0026ndash;30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0(0\u0026ndash;35.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.386\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePronation (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81.0(67.0\u0026ndash;93.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.0(30.0\u0026ndash;92.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.205\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupination (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79.0(71.0\u0026ndash;89.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.0(70.0\u0026ndash;87.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.153\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*One case of internal fixation failure per group was excluded\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData of range of movement represent median and range; HCS, headless compression screw; RLP, radial head locking plate.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComplications and Reoperation Indications at Final Follow-up\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHCS Group\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRLP Group\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal complication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22 (47.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinor complication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.526\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMajor complication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (32.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRe-operation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (32.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHardware removal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (28.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRevision surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (2.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (4.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.673\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHCS, headless compression screw; RLP, radial head locking plate.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical outcome\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBased on follow-up evaluations, one patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. Both fixation methods demonstrated favourable functional recovery, with no statistically significant differences in time to union or MEPS. Additionally, there were no significant differences in the range of movement of the elbow joint between the groups, including flexion, extension deficit, and forearm rotation (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn the HCS group, one patient underwent implant removal and radial head replacement at 7 months post-operatively due to non-union. Two cases showed 30\u0026deg; extension deficits with Hastings and Graham type IIA heterotopic ossification (HO), both managed with conservative treatment and physical rehabilitation. Two patients had posterior interosseous nerve injury with extensor digitorum weakness, resolving after conservative care. In one case, the screws was removed at 5 months post-operatively due to hardware irritation from excessive length.\u003c/p\u003e\u003cp\u003eIn the RLP group, one patient underwent implant removal and radial head replacement at 9 months post-operatively due to non-union. One case had a 35\u0026deg; extension deficit (type IIA HO), two showed pronation limitations (type IIB HO), and all were treated conservatively. One severe case with approximately 43\u0026deg; pronation loss compared to the contralateral side underwent surgical implant removal and soft tissue release. Posterior interosseous nerve (PIN) injury was observed in three patients, presenting as extensor digitorum weakness. Among them, two resolved and one retained grade 4 muscle strength at the final follow-up. 13 cases required plate removal for hardware-related pain or skin irritation and the symptoms disappeared postoperatively. No wound infections were observed in either group during the follow-up period.\u003c/p\u003e\u003cp\u003eThough the incidence of minor complications showed no difference between the two groups (10.5% vs. 15.2%, p\u0026thinsp;=\u0026thinsp;0.526), the HCS group demonstrated markedly lower rates of major complications requiring re-operation than the RLP group (5.3% vs. 32.6%, p\u0026thinsp;=\u0026thinsp;0.002). Therefore, a statistically significant difference was observed in overall complication rates between the two groups.\u003c/p\u003e\u003cp\u003eThe predominant indication for re-operation in the RLP group was symptomatic hardware irritation (2.6% vs. 28.3%, p\u0026thinsp;=\u0026thinsp;0.002), whereas revision surgery, such as movement restriction and implant failure, showed no significant differences between groups (2.6% vs. 2.2%, p\u0026thinsp;=\u0026thinsp;0.673, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRadial head fractures represent one of the most common elbow injuries, predominantly caused by indirect axial loading transmitted through the forearm[12]. The classification of radial head fractures has evolved since Mason introduced the original system in 1954, and Hotchkiss revised the classification in 1997[4]. The Mason classification system categorises these fractures into three types (Ⅰ-III) based on displacement severity and articular involvement, guiding treatment and rehabilitation strategies[4]. Conservative management typically achieves favourable outcomes in Mason type I fractures[13]. On the other hand, for Mason type III fractures, especially those that are comminuted and beyond reconstruction, arthroplasty is recommended. Mulders et al[3] have reported that nonoperatively treated adults with an isolated Mason type 2 radial head fracture with fragment displacement less than 2mm and Involving less than 30% of the articular surface had similar functional results after 1 year compared with operatively treated patients. However, for Mason type II with with mechanical obstruction, surgical fixation with implants such as plates and screws is generally required[14, 15]. Furthermore, severe comminuted radial head fractures with more than three fracture fragments are prone to early fixation failure and nonunion during fixation[16]. Therefore, we excluded severe comminuted fractures with more than three fracture fragments.\u003c/p\u003e\u003cp\u003eBiomechanical analysis of plate versus screw fixation for radial neck fractures with concomitant two-part radial head fractures demonstrated no statistically significant difference in stiffness under axial compression[17, 18]. Studies by Li et al[19] and Smith et al[8] reported satisfactory outcomes (MEPS score\u0026thinsp;\u0026gt;\u0026thinsp;90, Broberg and Morrey score good or excellent) with both plate and screw fixation for radial head fractures. The efficacy of plates and screws in the treatment of radial head fractures was compared in the study by Yano et al[20]. The results showed comparable efficacy of plate and screw in the treatment of radial head fractures and demonstrated a higher reoperation rate and complication rate in the RLP group. In our study, both groups achieved similar clinical outcomes, with comparable MEPS exceeding 90 points (p\u0026thinsp;=\u0026thinsp;0.394) and no statistically significant differences in post-operative range of movement across flexion-extension (p\u0026thinsp;=\u0026thinsp;0.577) or forearm rotation (p\u0026thinsp;=\u0026thinsp;0.153\u0026ndash;0.386).\u003c/p\u003e\u003cp\u003eIn our study, the major complication and reoperation rate were lower in the HCS group than in the RLP group. In the RLP group, most patients who underwent secondary surgery did so not because of pain or implant failure, but due to long-term discomfort caused by foreign body friction during forearm movement. The symptoms disappeared after the removal of the internal plant. Radial head locking plates restore native radial head anatomy and enhance neck stability[21]. The radial head was elliptical rather than perfectly round[22]. Additionally, the shape, angle, and curvature of the proximal radius varied greatly[23]. Thus, although anatomically contoured plates fit the radial head as closely as possible, the anatomical variations of the radial head make it difficult for the plates to completely match, which may be one reason for the increased complication rate. Moreover, the fixation area of the plates is limited to a safe zone, and improper placement can cause post-operative elbow joint mobility issues. Previous studies have shown that a larger dissection area during plate placement increases the rate of HO, thereby limiting rotation[8]. Anatomical studies reveal that the PIN lies within 3.8 cm of the radial articular surface[14]. This suggests that the exposure of the distal part of the radial head increases the risk of injury to the posterior interosseous nerve. Using headless compression screws reduces irritation of the internal fixator to the elbow joint and surrounding soft tissues while minimising the stripping of periosteum. Minimal distal soft tissue dissection optimally reduces the risk of PIN injury during surgical exposure.\u003c/p\u003e\u003cp\u003eThis study had certain limitations. Firstly, it was a retrospective study, and the surgeons were from the same treatment group, which introduced some variability in surgical procedures and fixation method choices. Secondly, when using screws to fix multiple fracture fragments, the possibility of screw interference must be considered, requiring higher surgical skills, which may affect the choice of the fixation method. Thirdly, elbow joint ligament injury was not evaluated in this study. Finally, due to the low incidence of radial head fractures, a considerable timeframe was required to include cases that may affect follow-up assessments. Future multicentre, large-sample prospective cohort studies are required to provide further clinical evidence.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFor internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eheadless compression screw\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRLP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eradial head locking plate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMEPS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMayo Elbow Performance Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eORIF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eopen reduction and internal fixation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e3D\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e3-dimensional\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecomputed tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVisual analogue scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePOT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epre-operative time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eoperation time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHST\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehospital stay time\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eheterotopic ossification\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePIN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eposterior interosseous nerve.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the ethics committee of Peking University Third Hospital (Approval Number: IRB00006761-M20250573). Informed consent was signed by each enrolled objective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e：\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e：\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e: \u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e: \u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThis work was supported by Fund progrmas: Beijing Municipal Health Commission(A82509-05)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e：\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eYF, YC, ZC, LB, and YL were all involved with the conception and design of the study, acquisition of data, analysis and interpretation of data, and drafting and revision of the article. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKlug A, Gramlich Y, Wincheringer D, et al. Epidemiology and Treatment of Radial Head Fractures: A Database Analysis of Over 70,000 Inpatient Cases. J Hand Surg Am 2021; 46;27-35.\u003c/li\u003e\n\u003cli\u003eThomas TT. XIV. Fractures of the Head and Neck of the Radius. Ann Surg 1907; 46;280-291.\u003c/li\u003e\n\u003cli\u003eMulders MAM, Schep NWL, de Muinck Keizer RO, et al. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. J Shoulder Elbow Surg 2021; 30;1670-1678.\u003c/li\u003e\n\u003cli\u003eHotchkiss RN. Displaced fractures of the Radial Head: internal fixation or excision? J Am Acad Orthop Surg. 1997;5:1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eKhawar H, Craxford S, Ollivere B. Radial head fractures. Br J Hosp Med (Lond). 2020;81(4):1-6.\u003c/li\u003e\n\u003cli\u003eKadam, A., Kadam, Dr. R., Challani, Dr. A., et al. A comparative study of functional outcome of type 2 and 3 radial head fracture treated with radial head excision versus radial head fixation. International Journal of Orthopaedics Sciences 2021; 7(1), 140\u0026ndash;142. \u003c/li\u003e\n\u003cli\u003eKumar P, Jindal K, Rajnish RK, et al. Excision Versus Replacement in Unrepairable Comminuted Fractures of the Radial Head: A Systematic Review of Outcomes and Complications. Indian J Orthop. 2022;56(8):1305-1315.\u003c/li\u003e\n\u003cli\u003eSmith AM, Morrey BF, Steinmann SP. Low profile fixation of radial head and neck fractures: surgical technique and clinical experience. J Orthop Trauma 2007; 21;718-724.\u003c/li\u003e\n\u003cli\u003eGruszka D, Nowak TE, Tkacz T, et al. Complex radial head and neck fractures treated with modern locking plate fixation. J Shoulder Elbow Surg 2019; 28;1130-1138.\u003c/li\u003e\n\u003cli\u003eKastenberger T, Kaiser P, Spicher A, et al. Clinical and radiological outcome of Mason-Johnston types III and IV radial head fractures treated by an on-table reconstruction. J Orthop Surg Res 2022; 17;503.\u003c/li\u003e\n\u003cli\u003eLongo UG, Franceschi F, Loppini M, et al. Rating systems for evaluation of the elbow. Br Med Bull 2008; 87;131-161.\u003c/li\u003e\n\u003cli\u003evan Riet RP, van den BekeroV M, van Tongel A, et al. Radial head fractures. Shoulder Elbow 2020; 12;212-223.\u003c/li\u003e\n\u003cli\u003eYoon A, King GJ, Grewal R. Is ORIF superior to nonoperative treatment in isolated displaced partial articular fractures of the radial head? Clin Orthop Relat Res 2014; 472;2105-2112.\u003c/li\u003e\n\u003cli\u003eZhao B, Wang H, Diao S, et al. Comparison of operatively and nonoperatively treated isolated mason type II radial head fractures: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19;540.\u003c/li\u003e\n\u003cli\u003eMannan M, Hamid MA, Shrivastava N, et al. Functional Outcomes of Radial Head Fractures Treated With Open Reduction and Internal Fixation (ORIF). Cureus 2024; 16;e74801.\u003c/li\u003e\n\u003cli\u003eRing D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 2002; 84;1811-1815.\u003c/li\u003e\n\u003cli\u003eRebgetz PR, Daniele L, Underhill ID, et al Biomechanical study of headless compression screws versus a locking plate in radial head fracture fixation. J Shoulder Elbow Surg 2019; 28;e111-e116.\u003c/li\u003e\n\u003cli\u003eYin H, Li Y, Zhao G, et al. [Finite element analysis of the stability of Mason type Ⅲ radial head fracture fixed with three cross-bridge headless compression screw and locking plate]. Zhongguo Gu Shang 2024; 37;57-60.\u003c/li\u003e\n\u003cli\u003eLi SL, Lu Y, Wang MY. Is cross-screw fixation superior to plate for radial neck fractures? Bone Joint J 2015; 97-b;830-835.\u003c/li\u003e\n\u003cli\u003eYano K, Fukuda M, Uemura T et al. Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation. Indian J Orthop 2023; 57;253-261.\u003c/li\u003e\n\u003cli\u003eSwensen SJ, Tyagi V, Uquillas C, et al. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol 2019; 20;15.\u003c/li\u003e\n\u003cli\u003evan Riet RP, Van Glabbeek F, Neale PG, et al. The noncircular shape of the radial head. J Hand Surg Am 2003; 28;972-978.\u003c/li\u003e\n\u003cli\u003eVan Riet RP, Van Glabbeek F, Neale PG, et al. Anatomical considerations of the radius. Clin Anat 2004; 17;564-569.\u003c/li\u003e\n\u003cli\u003eDiliberti T, Botte MJ, Abrams RA. Anatomical considerations regarding the posterior interosseous nerve during posterolateral approaches to the proximal part of the radius. J Bone Joint Surg Am 2000; 82;809-813.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Radial head fracture, Headless compression screw, Plate, Open reduction and internal Fixation","lastPublishedDoi":"10.21203/rs.3.rs-7209417/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7209417/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis retrospective study aimed to compare the efficacy of internal fixation using headless compression screws and radial head locking plate for comminuted radial head and neck fractures with no more than 3 displaced fragments.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study included 84 patients with radial head and neck fractures treated at Peking University Third Hospital between January 2013 and December 2022, with 38 and 46 patients in the headless compression screw (HCS) and radial head locking plate (RLP) groups, respectively. The main outcome was the comparison of complications between the two groups. Demographic data, pre-operative time (POT), operation time (OT), and hospital stay time (HST) were also recorded. The Mayo Elbow Performance Score (MEPS), range of movement of the elbow and forearm, and reasons for re-operation were compared between the two groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll patients were followed up for an average of 66.4 months (range, 20\u0026ndash;135 months). One patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. There was no statistically significant difference in the clinical outcomes between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.0023). Additionally, the re-operation rate due to symptomatic hardware was significantly higher in the RLP group (28.3%) than that in the HCS group (2.6%, p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eFor internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS.\u003c/p\u003e","manuscriptTitle":"Comparative study of Headless Compression Screws versus Radial head Locking Plate for Comminuted Radial Head and Neck Fractures.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 13:03:31","doi":"10.21203/rs.3.rs-7209417/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb6ba4cc-cf99-4d9b-bce8-85a4e3fbb999","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-21T10:08:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 13:03:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7209417","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7209417","identity":"rs-7209417","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}