The surgical outcome of postoperative radial neck nonunion: Retrospective case series with systematic review

Purposes: This study aim to describe surgical outcome in treating postoperative radial neck nonunion and to perform a systematic review to evaluate the surgical outcome of symptomatic radial neck nonunion. Methods: The study included ten patients with symptomatic postoperative radial neck nonunion from 2010 to 2016 which were treated surgically with either bone grafting (bone-grafting group) or radial head resection (resection group). The patient demographics, pre- and postoperative clinical scores were recorded. The PubMed, OVID/Medline, Cochrane, Google Scholar, and EMBASE databases were searched using the keywords “radial neck nonunion” according to the MeSH index. A systematic review was performed using PRISMA guidelines. Results: Average time from primary surgery to nonunion was 10.7 months. Four and six patients received bone-grafting and radial head resection procedure. The mean age for resection group is older than bone grafting group (59 versus 28.75 years). The resection group patients presented with more significant pre-operative symptoms, associated injuries, loss of radial head articular congruity, and bone loss. All patients achieved favorable outcome. The systematic review included 12 publications with a total of 19 patients. The incidence of radial neck nonunion was 73.7% and 26.3% following conservative and operative treatment respectively. About 42.1% received operative treatment due to symptomatic progression. Conclusions: Radial neck nonunion is rare and mostly appears asymptomatic. Operative treatment is advocated for symptomatic cases. Articular congruity and degree of bone loss are major determinant for surgical treatment of radial neck nonunion. Surgical treatment for symptomatic radial neck nonunion resulted in favorable outcome.