Year: 2025 | Month: April | Volume: 12 | Issue: 4 | Pages: 93-100
DOI: https://doi.org/10.52403/ijrr.20250411
Comparison of Clinical Outcomes after Open Reduction and Internal Fixation and Radial Head Arthroplasty for Treatment of Radial Head Fractures: A Systematic Review and Meta-Analysis
Andini Febriana1, Made Bramantya Karna2, AA. Gde Yuda Asmara3, Stedi Adnyana Christian4, I Gusti Ngurah Paramartha Wijaya Putra5
1Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. dr. I.G.N.G Ngoerah Hospital
2Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. dr. I.G.N.G Ngoerah Hospital
Corresponding Author: Andini Febriana
ABSTRACT
Introduction: Radial head fractures (RHF) constitute 33% of all elbow fractures. The Mason classification system, introduced in 1954 and modified in 1962, remains pivotal for prognostic and preoperative planning. Comminuted radial fractures (modified Mason type III and IV) provide difficult and contentious treatment issues. Numerous studies have been conducted on surgical procedures like radial head arthroplasty (RHA) and open reduction and internal fixation (ORIF). Previous meta-analyses suggest RHA may offer slightly superior elbow function and fewer unfavorable occurrences in the short term compared to ORIF for Mason type III RHF although the evidence quality is low. This study systematically reviews and compares the outcomes of ORIF versus RHA using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM) evaluations.
Method: PRISMA guidelines were used in conducting the systematic review. We searched Cochrane Library, PubMed, and Google Scholar for comprehensive, peer-reviewed English studies. that compared the results of ORIF plate screw and RHA in RHF. The inclusion criteria were studies comparing clinical outcomes of these operative treatments, with outcomes assessed including DASH score, quick DASH score, MEPS, and ROM. AHRQ, GRADE Working Group, and Oxford Center for Evidence-based Medicine criteria were used to evaluate the study's quality and bias risk.
Results: The initial search yielded 158 studies. After excluding duplicates and screening titles and abstracts, five studies met the inclusion criteria. All included studies were randomized controlled trials. The mean age of participants was over 35 years, with more males than females. The sample sizes varied, with most studies including over 30 patients. Subgroup analyses revealed significant differences between ORIF and RHA groups. In terms of the Mayo Elbow Performance Score (MEPS), plating was found to be more favorable, with a mean difference of 4.05 (95% CI, 0.11 to 8.00). For flexion range of motion (ROM), arthroplasty was superior, showing a mean difference of -1.88 (95% CI, -2.53 to -1.24). Pronation ROM favored plating with a mean difference of 2.63 (95% CI, 2.09 to 3.18), and supination ROM also favored plating, with a mean difference of 8.22 (95% CI, 7.50 to 8.95).
Conclusion: Based on the included studies, both ORIF and RHA are viable surgical options for RHF Mason type II and III fractures. Plating was more favorable for MEPS and supination/pronation ROM, while RHA was better for flexion ROM. More extensive studies are required to draw definitive conclusions and guide treatment strategies for RHF.
Keywords: Arthroplasty, ORIF, Radial head fracture
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