The aim of this systematic review was to search for and critically appraise articles directly comparing functional outcomes and complications for fixation (ORIF) versus arthroplasty for comminuted radial head fractures (Mason type 3) in adults.
Material and methods: A comprehensive study of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Strict eligibility criteria were applied to stringently screen resultant articles. Three comparative studies were identified and reviewed.
Results: Two studies found significantly better functional scores after replacement compared with ORIF in Mason type 3 fractures. The third study found no significant differences in functional score or range of motion, but did find that grip strength was better after ORIF. Complication rates were too heterogenous for conclusion.
Conclusion: Fixation with good reduction may be attempted in unstable Mason type 3 fractures, and arthroplasty may be considered if this is not possible. Further randomised comparative trials are required to clarify the decision-making between fixation and replacement. Functional outcomes and complications were conflicting in the studies included here. Ideally, treatment decision should take into account elbow stability and degree of comminution.
Morrey B. Radial head fracture. In: Morrey B, editor. The elbow and its disorders. 3rd ed. Philadelphia: WB Saunders, 2000: 341-364. ISBN 0721677525, 9780721677521.
Pike J, Athwal G, Faber M, King G. Radial head fractures - an update. J Hand Surg 2009; 34A: 557-565. doi: 10.1016/j.jhsa.2008.12.024.
Rosenblatt Y, Athwal G, Faber K. Current recommendations for the treatment of radial head fractures. Orthop Clin N Am 2008; 39: 173-185. doi: 10.1016/j.ocl.2007.12.008.
Harrington I, Tountas A. Replacement of the radial head in the treatment of unstable unstable elbow fractures. Injury 1981; 12: 405-412.
Harrison J, Chitre A, Lammin K, Warner J, Hodgson S. Radial head fractures in adults. Current Orthopedics 2007; 21: 59-64. http://dx.doi.org/10.1016/j.cuor.2006.10.003
Ring D. Displaced, unstable fractures of the radial head: Fixation vs replacement - What is the evidence? Injury 2008; 39: 1329-1337. doi: 10.1016/j.injury.2008.04.011
Mason M. Some observations on fracture of the head of the radius with review of one hundred cases. Br J Surg 1954; 42: 123-132.
Johnston G. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 1962; 31: 51-56.
Broberg M, Morrey B. Results of treatment of fracture dislocations of the elbow. Clin Orthop Rel Res 1987: 109-119.
Hotchkiss R. Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg 1997; 5: 1-10.
Schatzker J. Fractures of the radial head. In Schatzker J, Tile M, eds. The rationale of operative fracture care. 2nd ed. Springer-Verlag, 1996: 131-135. ISBN 3540593888, 9783540593881.
Roidis N, Papadakis S, Rigopoulos N, Basdekis G, Poulsides L, Karachalios T, Malizos K, Itamura J. Current concepts and controversies in the management of radial head fractures. Orthopedics 2006; 29(10): 904-916.
Sharpe F, Kuschner S. Radial head fractures. In: Baker C, Plancher K, editors. Operative treatment of elbow injuries. NewYork, NY: Springer-Verlag Inc, 2001: 207-233. ISBN 0387989056, 9780387989051
Akesson T, Herbertsson P, Josefsson P-O, Hasserius R, Besjakov J, Karlsson M. Primary nonoperative treatment of moderately displaced two-part fractures of the radial head. J Bone Joint Surg Am, 2006; 88(9): 1909-1914. doi: 10.2106/JBJS.E.01052.
Ring D, Quintero J, Jupiter J. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002; 84: 1811-1815.
Furry K, Clinkscales C. Comminuted fractures of the radial head: arthroplasty versus internal fixation. Clin Orth Rel Res 1998; 353: 40-52.
Hotchkiss R. Fractures and dislocations of the elbow. In Rockwood C, Green D, editors. Fractures in adults. 4th ed. Philadelphia, PA: Lippincott-Raven, 1996: 929-1024. ISBN 039751509X, 9780397515097.
McKee M, Jupiter J. Trauma to the adult elbow and fractures of the distal humerus. In: Browner B, Jupiter J, Levine A, Trafton P, editors. Skeletal trauma. 2nd ed. Philadelphia, PA: WB Saunders, 1998: 1455-1522. ISBN 0721668844, 9780721668840
Calfee R, Madom I, Weiss R. Radial head arthroplasty. J Hand Surg 2006; 31A: 314-321. doi: 10.1016/j.jhsa.2005.12.005.
Morrey B, An K, Stormont T. Force transmission through the radial head. J Bone Joint Surg 1988; 70A: 250-256.
Broberg M, Morrey B. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am. 1986; 68: 669-674.
Riet R, Morrey B. Documentation of associated injuries occurring with radial head fracture. Clin Orthop Relat Res 2008; 466: 130-134. doi: 10.1007/s11999-007-0064-8.
Knight D, Rymaszewski L, Amis A, Miller J. Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg 1993; 75B: 572-576.
Moro J, Werier J, MacDermid J. Arthroplasty with a metal radial head for unreconstructable fractures of the radial head. J Bone Joint Surg 2001; 83A: 1201-1211.
Speed K. Ferrule caps for the head of the radius. Surg Gynecol Obstet 1941; 73: 845.
Stuffman E, Baratz M. Radial head implant arthroplasty. J Hand Surgery 2009; 34A: 745-754. doi: 10.1016/j.jhsa.2009.01.027.
Clembosky G, Boretto J. Open reduction and internal fixation versus prosthetic replacement for complex fractures of the radial head. J Hand Surg 2009; 34(6): 1120-1123. doi: 10.1016/j.jhsa.2008.12.031.
Guyatt G, Sackett D, Cook D. Users’ guides to the medical literature. How to use an article about therapy or prevention. A. Are the results of the study valid? JAMA 1993; 270: 2598-2601.
Guyatt G, Sackett D, Cook D. Users’ guides to the medical literature. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? JAMA 1993; 271: 59-63.
Schulz K, Altman D, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c869. doi: 10.1136/bmj.c869.
Chen X, Wang S, Cao L, Yang G, Li M, Su J. Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multi-fragmented radial head fractures. International Orthopaedics (SICOT) 2011; 35: 1071-1076. doi: 10.1007/s00264-010-1107-4.
Ruan H, Fan C, Liu J, Zeng B. A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III. International Orthopaedics 2009; 33: 249-253. doi: 10.1007/s00264-007-0453-3
Boulas H, Morrey B. Evaluation of the elbow following radial head fracture. Comparison of open reduction and internal fixation vs. replacement, excision and non-operative management. Ann Hand Surg 1998; 17(4): 314-320.
No author named. Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009). http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ (accessed 19 January 2015)
Morrey B, Askew L, Chao E. Silastic prosthetic replacement for the radial head. J Bone Joint Surg 1981; 63A: 454-458.
McArthur R. Herbert screw fixation of fracture of the head of the radius. Clin Orthop Relat Res 1987; 224: 79-87.
Nalbantoglu U, Kocaoglu B, Gereli A, Aktas S, Guven O. Open reduction and internal fixation of Mason type III radial head fractures with and without an associated elbow dislocation. J Hand Surg 2007; 32A: 1560-1568. doi: 10.1016/j.jhsa.2007.09.016
Swanson A, Jaeger S, La Rochelle D. Comminuted fractures of the radial head. The role of silicone-implant replacement arthroplasty. J Bone Joint Surg 1981; 63A: 1039-1049.
Vanderwilde R, Morrey B, Melberg M, Vinh T. Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg 1994; 76B: 78-81.
Maghen Y, Leo AJ, Hsu JW, Hausmann MR. Is a silastic radial head still a reasonable option? Clin Orthop Relat Res 2011; 469(4): 1061-1070. doi: 10.1007/s11999-010-1672-2.
Colville-Stewart S. How to do a literature search. The essential researcher’s handbook for healthcare professionals. 2nd ed. London: Bailliere Tindall, 2002: 35-53. ISBN 0702026360, 9780702026362.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.