Open reduction and internal fixation versus resection for radial head fractures: a meta-analysis

Purpose: Radial head resection and open reduction and internal fixation (ORIF) are the traditional techniques for the treatment of radial head fractures (RHFs). The existing literature has not identified which is superior. We performed a meta-analysis of the current literature on excision and ORIF for RHFs to reach a relatively conclusive answer. Methods: A search was performed in PubMed, OVID, EMBASE, and Cochrane Library for articles published on RHFs. We extracted and pooled patient data using standard meta-analytic approaches. The outcomes were compared using measures of functional rating score, grip strength, range of motion, pain score, physicianrated questionnaire, and complication rates. Outcomes were pooled by random-effects if high heterogeneity was detected. Sensitivity analyses were used to test the stability of the meta-analysis results under different assumptions. Results: Four studies involving 162 patients were considered eligible for analysis. Results showed ORIF was more effective for avoiding flexion contracture and degenerative change complications. For functional outcome (The American Shoulder and Elbow Surgeons Elbow Evaluation Instrument, The Broberg and Morrey functional rating score, The classification rating, The patient-based Disabilities of the Arm, Shoulder, and Hand questionnaire), ORIF had a superior capability to resection. As for the loss of grip strength, the arc of flexion/extension of the elbow and pronation/supination of the forearm, pain relief, and radiographic proximal migration of the radius, there were no significant differences between two interventions. Conclusions: To sum up, considering all these pooled outcomes, we recommend ORIF over Resection for the treatment of RHFs.