Treatment of Mason Type II Radial Head Fractures Without Associated Fractures or Elbow Dislocation: A Systematic Review

Abstract

There is no consensus as to the best treatment of Mason type II fractures without concomitant elbow fractures or dislocation. The aim of this systematic review was to compare the results of operative and nonoperative treatment of these injuries. We systematically screened the databases of PubMed, EMBASE, and Cochrane Library until September 2011 for studies on nonoperative or operative treatment of Mason type II fractures. We defined successful treatment as an excellent or good result according to the Broberg and Morrey score, Mayo Elbow Performance Score, or Radin score. Exclusion criteria were duration of follow-up of less than 6 months, an improperly described therapy or combination of therapies, skeletal immaturity, and articles written in languages other than English. Among 717 studies, 9 retrospective case series (level IV) describing 224 patients satisfied our inclusion criteria. Nonoperative treatment was successful in 114 of 142 patients (80%) pooled from the studies (42% to 96% success in individual studies). Open reduction and internal fixation was successful in 76 of 82 patients (93%) (81% to 100% success in individual studies). Only a few studies with a low level of evidence address the treatment of isolated, displaced, partial articular fractures. There is a need for sufficiently powered randomized, controlled trials. There is insufficient evidence to draw firm conclusions on the optimal treatment of isolated, displaced, partial articular Mason type II fractures.