Clinical outcomes after internal fixation, arthroplasty and resection for treatment of comminuted radial head fractures:
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REVIEW
Clinical outcomes after internal fixation, arthroplasty and resection for treatment of comminuted radial head fractures: a systematic review and network meta‑analysis K. Chaijenkij1 · A. Arirachakaran2 · J. Kongtharvonskul3 Received: 29 October 2019 / Accepted: 5 August 2020 © Istituto Ortopedico Rizzoli 2020
Abstract Background Radial head fractures make up approximately 3% of all fractures, and they are the most common elbow fracture in adults. The treatment for comminuted radial head fracture remains controversial. This systematic review was conducted with the aim to compare postoperative outcomes among surgical treatments to identify which method is the best for comminuted radial head fractures. Methods Relevant studies were identified from Medline and Scopus from inception to February 22, 2020, that reported Mayo Elbow Performance Index (MEPI) score and postoperative complications of either treatment. A network meta-analysis was applied to assess treatment outcomes. Probability of being the best treatment was estimated using surface under the cumulative ranking curves (SUCRA). Results Twelve comparative studies and one randomized controlled trial (N = 526 patients) met the inclusion criteria. Interventions included open reduction and internal fixation (ORIF) (N = 210 patient), radial head arthroplasty (RHA) (N = 227 patients) and radial head resection (RHR) (N = 152 patients). A network meta-analysis showed that the MEPI of RHA was significantly higher when compared to ORIF and RHR, with a pooled mean MEPI of 7.28 (1.69, 12.86) and − 7.32 (− 13.21, − 1.43), respectively. In terms of complications, RHA and RHR had lower risk with RRs of 0.61 (0.29, 1.31) and 0.54 (0.24, 1.25) when compared to ORIF. The SUCRA probabilities of RHA and RHR were in the first rank with 99.2% in MEPI and 60.6% in complications, respectively. Conclusions This study suggests that RHA is the best treatment of choice for efficacy and safety in the treatment of comminuted radial head fracture, while RHR is the safest choice to minimize postoperative complications and enable patients to perform all daily life activities. Keywords Open reduction and internal fixation · Resection · Arthroplasty · Comminuted radial head fracture Abbreviations RHF Radial head fracture ORIF Open reduction and internal fixation RHR Radial head resection RHA Radial head arthroplasty PROSPERO Prospective Register of Systematic Reviews MEPI Mayo Elbow Performance Index SD Standard deviation Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12306-020-00679-3) contains supplementary material, which is available to authorized users. * J. Kongtharvonskul [email protected] Extended author information available on the last page of the article
UMD Unstandardized mean difference RR Relative risk SUCRA Surface under the cumulative ranking curves RCT Randomized controlled trial
Background Fractures of the radial head (RHF) account for 4% of all fractures and 33% of all elbow fractures [1, 2]
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