Comparison of operatively and nonoperatively treated isolated mason type II radial head fractures: a systematic review and meta-analysis

Abstract

Background: Radial head fractures are the most common bony injury of the elbow in adults. The current literature does not agree on whether isolated stable type II radial head fractures should be treated operatively or nonoperatively. This review aims to determine the preferred treatment for Mason type II radial head fractures and compare the outcomes of conservative and surgical treatment.

Methods: Our study used PRISMA guidelines and conducted a thorough search of multiple electronic databases, including PubMed, Cochrane, Embase, Web of Science, CNKI, and Wanfang databases, initially identifying 545 relevant publications on surgical and conservative treatment of Mason type II radial head fractures. The final search date for this study is July 7, 2024.Through a comprehensive meta-analysis, we evaluated several outcomes, including functional scores (DASH, OES, and MEPS scores), clinical outcomes (elbow flexion, elbow extension deficit, elbow pronation, and elbow supination), and complication rate (total complications and elbow pain). The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes.

Result: A total of 271 patients from 4 studies met the inclusion criteria. Among them, 142 patients received surgical treatment and 129 patients received non-surgical treatment. The study found no statistically significant differences between surgical and non-surgical treatments in DASH, OES, MEPS, elbow flexion, elbow extension impairment, and elbow pain. Compared with surgical treatment, non-surgical treatment was associated with greater elbow pronation (OR = -3.10, 95% CI = [-4.96, -1.25], P = 0.55, I² = 0%) and a lower complication rate (OR = 5.54, 95% CI = [1.79, 17.14], P = 0.42, I² = 0%).

Conclusion: Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications.

Keywords: Conservative; Meta-analysis; Operative; Radial head.

Fig. 1

Flow diagram of screening the included studies in the meta-analysis

Fig. 2

Review authors’ judgments about each risk of bias item for each included study. (a) Risk of bias summary; (b) risk of bias graph presented as percentages

Fig. 3

DASH

Fig. 4

OES

Fig. 5

MEPS

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Elbow flexion

Fig. 7

Elbow extension deficit

Fig. 8

Elbow pronation

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Elbow supination

Fig. 10

Total complications

Fig. 11

Elbow pain