Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis

  • Hao Sun
  • Jun Duan
  • Fengsheng LiEmail author
Original Article • ELBOW - FRACTURES



Open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) are the most common operative treatments in patients with radial head fractures. The purpose of this study was to determine the efficacy of RHA and ORIF treatments in patients with radial head fractures (modified Mason type III and IV).


We conducted a computerized search of five electronic databases from their inception to July 2015. All clinical trials comparing ORIF versus RHA treatment in patients with radial head fractures were included. We evaluated the primary outcomes included elbow functional evaluation criteria by Broberg and Morrey, elbow score (Broberg and Morrey), Mayo Elbow Performance Score (MEPS) and QuickDASH score. Secondary outcomes included Visual Analog Scale (VAS), range of motion, operation time and complications. The “assessing risk of bias” table was applied to assess the risk of bias of the included studies.


Eight studies were included in this meta-analysis, which consisted of 138 cases of ORIF and 181 RHA. Methodological quality of the studies was moderate to low. RHA afforded significantly higher satisfaction rate, better elbow score (Broberg and Morrey) and MEPS, shorter operation time, lower incidence of bone nonunion or absorption and internal fixation failure when compared to ORIF. There were no significantly differences in QuickDASH score and other complications.


RHA has better outcome in patients with radial head fractures (modified Mason type III and IV) than ORIF with medium-short-term follow-up period, but longer-term studies will be required to ascertain whether the apparent benefits of RHA were offset by late complications.

Level of evidence

Therapeutic decision analysis; a meta-analysis, Level III.


Radial head fracture Terrible triad injuries Radial head fixation Radial head arthroplasty Meta-analysis 



We thank the fourth affiliated hospital of Jinan University for assistance in obtaining the texts, which formed the basis of this meta-analysis.

Compliance with ethical standards

There was no fund support in our study. The authors declare that they have no competing interests. This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest



  1. 1.
    Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM (2012) The epidemiology of radial head and neck fractures. J Hand Surg Am 37(5):112–119. doi: 10.1016/j.jhsa.2011.09.034 CrossRefPubMedGoogle Scholar
  2. 2.
    Kaas L, van Riet RP, Vroemen JP, Eygendaal D (2010) The epidemiology of radial head fractures. J Shoulder Elbow Surg 19(6):520–523. doi: 10.1016/j.jse.2009.10.015 CrossRefPubMedGoogle Scholar
  3. 3.
    Kaas L, Struijs PA, Ring D, van Dijk CN, Eygendaal D (2012) Treatment of Mason type II radial head fractures without associated fractures or elbow dislocation: a systematic review. J Hand Surg Am 37(1):1416–1421. doi: 10.1016/j.jhsa.2012.03.042 CrossRefPubMedGoogle Scholar
  4. 4.
    Bruinsma W, Kodde I, de Muinck Keizer RJ, Kloen P, Lindenhovius AL, Vroemen JP (2014) A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial. BMC Musculoskelet Disord 6(15):140–147. doi: 10.1186/1471-2474-15-147 Google Scholar
  5. 5.
    Delclaux S, Lebon J, Faraud A, Toulemonde J, Bonnevialle N, Coulet B (2015) Complications of radial head prostheses. Int Orthop 39(7):907–913. doi: 10.1007/s00264-015-2689-7 CrossRefPubMedGoogle Scholar
  6. 6.
    Hall JA, McKee MD (2008) Posterolateral rotatory instability of the elbow following radial head resection. J Bone Joint Surg Am 8(3):1571–1579. doi: 10.2106/jbjs.d.02829 Google Scholar
  7. 7.
    Allieu Y, Winter M, Pequignot JP (2006) Radial head replacement with a pyrocarbon head prosthesis: preliminary results of a multicentric prospective study. Eur J Orthop Surg Traumatol 16(1):1–9. doi: 10.1007/s00590-005-0041-4 CrossRefGoogle Scholar
  8. 8.
    Ring D (2004) Open reduction and internal fixation of fractures of the radial head. Hand Clin 20(4):415–427. doi: 10.1016/j.hcl.2004.06.001 CrossRefPubMedGoogle Scholar
  9. 9.
    Ring D (2011) Radial head fracture: open reduction-internal fixation or prosthetic replacement. J Shoulder Elbow Surg 20(8):107–112. doi: 10.1016/j.jse.2010.11.011 CrossRefGoogle Scholar
  10. 10.
    Li N, Chen S (2014) Open reduction and internal-fixation versus radial head replacement in treatment of Mason type III radial head fractures. Eur J Orthop Surg Traumatol 24(6):851–855. doi: 10.1007/s00590-013-1367-y CrossRefPubMedGoogle Scholar
  11. 11.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2013) Measuring inconsistency in meta-analyses. BMJ Br Med J 327(2):557. doi: 10.1136/bmj.327.7414.557 Google Scholar
  12. 12.
    Ruan HJ, Fan CY, Liu JJ, Zeng BF (2009) A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III. Int Orthop 33(7):249–253. doi: 10.1007/s00264-007-0453-3 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Chen X, Wang SC, Cao LH, Yang GQ, Li M, Su JC (2011) Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multi-fragmented radial head fractures. Int Orthop 35(2):1071–1076. doi: 10.1007/s00264-010-1107-4 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Leigh WB, Ball CM (2012) Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow. J Shoulder Elbow Surg 21(6):1336–1341. doi: 10.1016/j.jse.2012.03.005 CrossRefPubMedGoogle Scholar
  15. 15.
    Watters TS, Garrigues GE, Ring D, Ruch DS (2014) Fixation versus replacement of radial head in terrible triad: Is there a difference in elbow stability and prognosis? Clin Orthop Relat Res 472(3):2128–2135. doi: 10.1007/s11999-013-3331-x CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Schnetzke M, Aytac S, Deuss M, Studier-Fischer S, Swartman B, Muenzberg M (2014) Radial head prosthesis in complex elbow dislocations: effect of oversizing and comparison with ORIF. Int Orthop 38(4):2295–2301. doi: 10.1007/s00264-014-2478-8 CrossRefPubMedGoogle Scholar
  17. 17.
    Al-Burdeni S, Abuodeh Y, Ibrahim T, Ahmed G (2015) Open reduction and internal fixation versus radial head arthroplasty in the treatment of adult closed comminuted radial head fractures (modified Mason type III and IV). Int Orthop. doi: 10.1007/s00264-015-2755-1 PubMedGoogle Scholar
  18. 18.
    Liu R, Liu P, Shu H, Gong J, Sun Q, Wu J (2015) Comparison of primary radial head replacement and ORIF (open reduction and internal fixation) in Mason type III fractures: a retrospective evaluation in 72 elderly patients. Med Sci Monit 21(5):90–93. doi: 10.12659/msm.893048 PubMedPubMedCentralGoogle Scholar
  19. 19.
    Yan M, Ni J, Song D, Ding M, Liu T, Huang J (2015) Radial head replacement or repair for the terrible triad of the elbow: which procedure is better? ANZ J Surg. doi: 10.1111/ans.13060 Google Scholar
  20. 20.
    Athwal GS, Frank SG, Grewal R, Faber KJ, Johnson J, King GJ (2010) Determination of correct implant size in radial head arthroplasty to avoid over lengthening surgical technique. J Bone Joint Surg Am. doi: 10.2106/jbjs.j.00356 PubMedGoogle Scholar
  21. 21.
    Van Glabbeek F, Van Riet RP, Baumfeld JA, Neale PG, O’Driscoll SW, Morrey BF (2004) Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg Am 86(4):2629–2635PubMedGoogle Scholar
  22. 22.
    van Riet RP, Sanchez J, Morrey BF (2010) Failure of metal radial head replacement. J Bone Joint Surg Br 92(3):661–667. doi: 10.1302/0301-620x.92b5.23067 CrossRefPubMedGoogle Scholar
  23. 23.
    Ha AS, Petscavage JM (2012) Radial head arthroplasty: a radiologic outcome study. AJR Am J Roentgenol 199:1078–1082. doi: 10.2214/ajr.11.7674 CrossRefPubMedGoogle Scholar
  24. 24.
    Hartzler RU, Morrey BF, Steinmann SP, Llusa-Perez M, Sanchez-Sotelo J (2014) Radial head reconstruction in elbow fracture-dislocation: Monopolar or bipolar prosthesis? Clin Orthop Relat Res 472(3):2144. doi: 10.1007/s11999-014-3672-0 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  1. 1.Department of Orthopedics, Guangzhou Red Cross HospitalThe Fourth Affiliated Hospital of JiNan UniversityGuangzhouChina

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