{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:24:16Z","timestamp":1793165056901,"version":"4.5.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The treatment of displaced or comminuted Mason\u2013Johnston type IV radial head fractures is challenging. These fractures often involve complex injuries to the ligaments surrounding the radial head, necessitating careful consideration of treatment strategies that prioritize ligament repair while preserving the integrity of the radial head whenever feasible. The primary objective of this study was to assess the clinical outcomes of open reduction and internal fixation (ORIF) in managing complex radial head fractures associated with transolecranon fractures, Monteggia fractures, and terrible triad injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between June 2015 and July 2019, twenty patients who underwent ORIF using screws, with or without mini plates, were retrospectively included in the current study to assess the outcomes for Mason\u2013Johnston type IV fractures of the radial head. Based on the initial Mason classification, fourteen fractures were classified as Mason type II, while six were classified as type III. Among these patients, fourteen had terrible triad elbow injuries, three presented with transolecranon fracture and elbow dislocation, two with Monteggia fractures of Bado type II, and one with concomitant fracture of the radial head and elbow dislocation. Both clinical and radiographic evaluations were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average duration of follow-up was 31 months, with a range of 24\u201340 months, and all patients achieved union without any evidence of postsurgical ligamentous instability or failure of internal fixation. The average range of motion for the affected elbow was 136\u00b0\u2009\u00b1\u20096\u00b0 of flexion, 12\u00b0\u2009\u00b1\u20096\u00b0 of extension, 74\u00b0\u2009\u00b1\u200910\u00b0 of pronation, and 67\u00b0\u2009\u00b1\u20099\u00b0 of supination, resulting in a flexion-extension arc of 123\u00b0\u2009\u00b1\u20096\u00b0 and a pronosupination arc of 142\u00b0\u2009\u00b1\u20098\u00b0. The Broberg and Morrey clinical score averaged 88\u2009\u00b1\u20098 (range 75\u2013100), with excellent outcomes observed in six patients, good outcomes in ten patients, and fair outcomes in four patients. Three out of 20 patients (15%) exhibited periarticular ossification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results of the current study suggest that satisfactory elbow function can be achieved following ORIF for Mason\u2013Johnston type IV fractures of the radial head.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1506125","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T05:15:33Z","timestamp":1747631733000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The clinical outcomes of open reduction and internal fixation for Mason\u2013Johnston type IV fractures of the radial head"],"prefix":"10.3389","volume":"12","author":[{"given":"Guanyi","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ding","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1002\/bjs.18004217203","article-title":"Some observations on fractures of the head of the radius with a review of one hundred cases","volume":"42","author":"Mason","year":"1954","journal-title":"Br J Surg"},{"key":"B2","first-page":"51","article-title":"A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature","volume":"31","author":"Johnston","year":"1962","journal-title":"Ulster Med J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1080\/2000656X.2018.1520122","article-title":"Reverse vascularized bone graft of the lateral distal humerus for non-union of the radial neck fracture: anatomical study and case report","volume":"53","author":"Nakanishi","year":"2019","journal-title":"J Plast Surg Hand Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"403.e1","DOI":"10.1016\/j.jhsa.2021.11.006","article-title":"Effect of radiocapitellar joint over\/under stuffing on elbow joint contact pressure","volume":"48","author":"Ramazanian","year":"2023","journal-title":"J Hand Surg Am"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1302\/0301-620x.85b7.13823","article-title":"Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates","volume":"85","author":"Ikeda","year":"2003","journal-title":"J Bone Joint Surg Br"},{"key":"B6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.2106\/JBJS.C.01323","article-title":"Comminuted fractures of the radial head. 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