Excision Versus Replacement in Unrepairable Comminuted Fractures of the Radial Head: A Systematic Review of Outcomes and Complications.

Abstract

The radial head fractures comprise approximately 4% of all fractures around the elbow. The outcomes of open reduction and internal fixation are poor in fractures with more than three fragments, and the excision of radial head is considered a viable surgical treatment option. However, it is associated with its own set of complications. The radial head prosthetic replacement has emerged as an alternative in management of these fractures with constraints of cost and related complications. Hence, the treatment for the unrepairable comminuted radial head fractures still remains controversial. This systematic review and meta-analysis was conducted to compare the post-operative outcomes of the radial head excision versus prosthetic replacement in comminuted Mason type-III fractures of radial head. Three databases of Medline (PubMed), Scopus, and Embase were searched for comparative studies on the study question and relevant studies which mentioned at least one of the outcomes of interest (functional outcome scores and number of complications) were included. Six studies were part of this review with 82 excisions and 99 prosthetic replacements. There was no significant difference between the two groups in terms of number of complications (OR 0.65; 0.08-5.07); and measures of functional outcomes; Mayo elbow performance score or MEPS (mean difference - 6.56; - 23.45 to 10.33). The incidence of elbow osteoarthritis, heterotrophic ossification, stiffness, and instability were similar in both groups. The flexion extension arc in degrees was better in excision group (mean difference 9.93; 1.31-18.55; p = .02). Excision is a reasonable surgical option for isolated comminuted radial head fractures with similar results of function and associated rates of complications as prosthetic replacements. The arc of motion is also better with excisions. There have been reports of more osteoarthritis with excision and arthroplasty has been advised in younger patients; however, we had no quantitative proof of that in this review.