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Clinical outcomes after internal fixation, arthroplasty and resection for treatment of comminuted radial head fractures: a systematic review and network meta-analysis

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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.

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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

UMD:

Unstandardized mean difference

RR:

Relative risk

SUCRA:

Surface under the cumulative ranking curves

RCT:

Randomized controlled trial

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Acknowledgements

All authors declare no sponsor involvement in the study design, collection, analysis and interpretation of the data, in writing the manuscript and in submission of the manuscript for publication.

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Authors and Affiliations

  1. Orthopedic Department, College of Sports Science and Technology, Mahidol University, Bangkok, Thailand

    K. Chaijenkij

  2. Orthopedics Department, Bumrungrad International Hospital, Bangkok, Thailand

    A. Arirachakaran

  3. Sport and Orthopedic Center, Samitivej Hospital and Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand

    J. Kongtharvonskul

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  1. K. Chaijenkij
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KC was responsible for the conception and design, collection and assembly of data, analysis and interpretation of the data, drafting of the manuscript and final approval of the article. AA was responsible for conception and design, drafting of the article, critical revision of the article for important intellectual content and final approval of the article. JK was responsible for the conception and design, collection and assembly of data, supervise in analysis and interpretation of the data, writing the manuscript, critical revision of the manuscript for important intellectual contents, final approval of the article and statistical expertise.

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Correspondence to J. Kongtharvonskul.

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This article was previously published in the International Archives of Orthopaedic Surgery without the permission of the authors. Subsequently, the article has been removed from the International Archives of Orthopaedic Surgery’s website. The authors would like to make the readers aware that this current article is the version of record.

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Table 4 Criteria for risk of bias assessment
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Chaijenkij, K., Arirachakaran, A. & Kongtharvonskul, J. Clinical outcomes after internal fixation, arthroplasty and resection for treatment of comminuted radial head fractures: a systematic review and network meta-analysis. Musculoskelet Surg 105, 17–29 (2021). https://doi.org/10.1007/s12306-020-00679-3

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