Radial Head Arthroplasty (RHA) versus Open Reduction and Internal Fixation (ORIF) for mason type III and IV fractures: A systematic review and meta-analysis

Title : Radial Head Arthroplasty (RHA) versus Open Reduction and Internal Fixation (ORIF) for mason type III and IV fractures: A systematic review and meta-analysis

Abstract:

The aim of this systematic review and meta-analysis was to compare the clinical outcomes of Radial Head Arthroplasty (RHA) and Open Reduction and Internal Fixation (ORIF) for Mason type III and IV radial head fractures. A comprehensive search identified eight cohort studies including a total of 457 patients. Outcome measures assessed included Range Of Motion (ROM), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and complication rates. Statistical analyses were performed to evaluate differences between the two surgical techniques, and heterogeneity was assessed using the I² statistic. Radial Head Arthroplasty (RHA) was associated with significantly improved elbow extension, higher MEPS scores, and lower complication rates compared to ORIF, particularly in cases with severe comminution or Mason type IV fractures. In contrast, ORIF demonstrated comparable outcomes in long-term ROM and DASH scores, especially in younger patients with less complex fracture patterns. Radial Head Arthroplasty (RHA) appears to offer superior functional outcomes and fewer complications in appropriately selected patients, while ORIF remains a viable option for younger individuals with simpler fracture configurations. Surgical decisions should be individualized based on fracture severity, patient factors, and surgeon expertise. Further high-quality randomized controlled trials are necessary to establish definitive treatment guidelines.

Keywords: Radial head fracture, Radial head arthroplasty, Open reduction internal fixation, Mason classification, Elbow trauma, Systematic review, Meta-analysis

Biography:

Eslam Hassan is a Senior Clinical Fellow in Trauma and Orthopaedics at a Major Trauma Centre in Cardiff, UK. He completed his medical degree in Cairo and holds a Master’s in Orthopaedic Surgery from Ain Shams University. He is a Member of the Royal College of Surgeons (MRCS) and has been working in the NHS since 2020 with full GMC registration. He has a broad range of clinical experience, with a logbook of over 450 procedures and a particular interest in trauma surgery. He has published five peer-reviewed papers and presented a systematic review and meta-analysis at EFORT and WIMTO. He holds certifications in ATLS, BSS, and AO Basic, and is actively involved in surgical education, having organised surgical skills courses and contributed to audits and quality improvement initiatives.