A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial

Wendy E Bruinsma, Izaäk F Kodde, Robert-Jan O de Muinck Keizer, Peter Kloen, Anneluuk LC Lindenhovius, Jos PAM Vroemen, Robert Haverlag, Michel PJ van den Bekerom, Hugo W Bolhuis, Pieter HJ Bullens, Sven AG Meylaerts, Peer van der Zwaal, E Philip Steller, Michiel Hageman, David C Ring, Dennis den Hartog, Eric R Hammacher, Graham JW King, George S Athwal, Kenneth J Faber, Darren Drosdowech, Ruby Grewal, J Carel Goslings, Niels WL Schep, Denise Eygendaal

The choice between operative or nonoperative treatment is questioned for partial articular fractures of the radial head that have at least 2 millimeters of articular step-off on at least one radiograph (defined as displaced), but less than 2 millimeter of gap between the fragments (defined as stable) and that are not associated with an elbow dislocation, interosseous ligament injury, or other fractures. These kinds of fractures are often classified as Mason type-2 fractures. Retrospective comparative studies suggest that operative treatment might be better than nonoperative treatment, but the long-term results of nonoperative treatment are very good. Most experts agree that problems like reduced range of motion, painful crepitation, nonunion or bony ankylosis are infrequent with both nonoperative and operative treatment of an isolated displaced partial articular fracture of the radial head, but determining which patients will have problems is difficult. A prospective, randomized comparison would help minimize bias and determine the balance between operative and nonoperative risks and benefits.