{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:56Z","timestamp":1787028656371,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health\u2014\u201cRicerca Corrente\u201d"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Various surgical methods have been proposed for the treatment of comminuted Mason III\/IV radial head fractures. In particular, the advantages and disadvantages between prosthesis implantation (RHA) or radial head resection (RHR) are not sufficiently quantified in the current literature. Methods: A systematic literature search was conducted using PubMed Web of Science, Cochrane Library, and Embase in February 2024. Studies conducted on patients with Mason type III or IV radial head fractures and studies relating to surgical methods, including radial head resection or Radial head prosthesis implantation, were included. The two methods were evaluated in terms of clinical and functional results through the DASH score (Disability of the arm, shoulder, and hand), Mayo Elbow Performance Index (MEPI), and flexion-extension range of motion. The onset of osteoarthritis and complications were also assessed. Risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 345 articles were evaluated and, of these, 21 were included in the study for a total of 552 patients. The results of the meta-analysis showed no significant differences in favor of RHA or RHR in terms of Mayo Elbow Performance (p = 0.58), degrees of flexion (p = 0.689), degrees of extension deficit (p = 0.697), and overall incidence of complications (p = 0.389), while it highlighted a statistically significant difference in terms of DASH score (19.2 vs. 16.2, respectively; p = 0.008) and subjects who developed osteoarthritis (13.4% vs. 47.3%, respectively; p = 0.046). Conclusions: The results of this meta-analysis confirm that both surgical methods provide good functional outcomes, with no significant differences in MEPI, DASH, and range of motion. However, a higher incidence of post-traumatic osteoarthritis was observed in patients undergoing RHR. Additionally, RHR patients exhibited slightly worse functional outcomes in the DASH score; however, this difference is not substantial enough to be considered clinically significant. These findings suggest that while both techniques are viable, RHA may be preferable in patients at higher risk of joint degeneration and instability, and the choice of treatment should be tailored to individual patient characteristics.<\/jats:p>","DOI":"10.3390\/jcm14051773","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T06:02:13Z","timestamp":1741240933000},"page":"1773","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comminuted Mason III\/IV Radial Head Fractures: What Is the Best Treatment Between Prosthesis and Radial Head Resection? A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9093-6309","authenticated-orcid":false,"given":"Luca","family":"Bianco Prevot","sequence":"first","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014S. Ambrogio, 20157 Milan, Italy"},{"name":"Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6147-3600","authenticated-orcid":false,"given":"Livio Pietro","family":"Tronconi","sequence":"additional","affiliation":[{"name":"Department of Human Science, European University of Rome, 00163 Rome, Italy"},{"name":"Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3419-3002","authenticated-orcid":false,"given":"Vittorio","family":"Bolcato","sequence":"additional","affiliation":[{"name":"Maria Beatrice Hospital, GVM Care & Research, 50121 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Accetta","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014S. Ambrogio, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6368-2614","authenticated-orcid":false,"given":"Stefania","family":"Fozzato","sequence":"additional","affiliation":[{"name":"Presidio Ospedaliero di Rho\u2014ASST Rhodense, 20017 Rho, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9602-4223","authenticated-orcid":false,"given":"Giuseppe","family":"Basile","sequence":"additional","affiliation":[{"name":"IRCCS Ospedale Galeazzi\u2014S. Ambrogio, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"ref_1","first-page":"20","article-title":"Radial head fractures","volume":"8","author":"Arya","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1007\/s11999-012-2319-2","article-title":"In brief: The Mason classification of radial head fractures","volume":"470","author":"Iannuzzi","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s10195-019-0523-5","article-title":"Maximizing outcomes in the treatment of radial head fractures","volume":"23","author":"Swensen","year":"2019","journal-title":"J. Orthop. Traumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/01.blo.0000180606.30981.78","article-title":"Associated injuries complicating radial head fractures: A demographic study","volume":"441","author":"Morrey","year":"2005","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2309499018802506","DOI":"10.1177\/2309499018802506","article-title":"Open reduction and internal fixation for Mason type III radial head fractures: Is it different from that for Mason type II fractures?","volume":"26","author":"Lee","year":"2018","journal-title":"J. Orthop. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1007\/s00264-010-1107-4","article-title":"Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multi-fragmented radial head fractures","volume":"35","author":"Chen","year":"2011","journal-title":"Int. Orthop."},{"key":"ref_7","first-page":"263","article-title":"Radial head prosthesis disassembly: Case report and medico-legal implications","volume":"28","author":"Basile","year":"2024","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/1758573214524934","article-title":"Functional outcomes post-radial head arthroplasty: A systematic review of literature","volume":"6","author":"Kaur","year":"2014","journal-title":"Shoulder Elb."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"29","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/j.joca.2019.03.004","article-title":"Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: Comparison with plain radiograph-based classification and clinical assessment","volume":"27","author":"Kwak","year":"2019","journal-title":"Osteoarthr. Cartil."},{"key":"ref_11","first-page":"355","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"12","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_12","unstructured":"Ryan, R., and Hill, S. (2016). How to GRADE the Quality of the Evidence, Cochrane Consumers and Communication Group."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/jrsm.12","article-title":"A basic introduction to fixed-effect and random-effects models for meta-analysis","volume":"1","author":"Borenstein","year":"2010","journal-title":"Res. Synth. Methods"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jclinepi.2006.11.003","article-title":"Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews","volume":"60","author":"Walter","year":"2007","journal-title":"J. Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s12306-022-00745-y","article-title":"Mason type III fractures of the radial head: ORIF, resection or prosthetic replacement?","volume":"107","author":"Scoscina","year":"2023","journal-title":"Musculoskelet. Surg."},{"key":"ref_16","first-page":"242","article-title":"Modified Mason type III and IV radial head fractures: Results of different surgical treatments","volume":"86","author":"Pogliacomi","year":"2015","journal-title":"Acta Biomed."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1080\/08941939.2019.1602689","article-title":"Therapeutic Effect of Resection, Prosthetic Replacement and Open Reduction and Internal Fixation for the Treatment of Mason Type III Radial Head Fracture","volume":"34","author":"Chen","year":"2021","journal-title":"J. Investig. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/17453674.2017.1293440","article-title":"A radial head prosthesis appears to be unnecessary in Mason-IV fracture dislocation","volume":"88","author":"Nestorson","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/S0020-1383(16)30603-9","article-title":"Comminuted fractures of the radial head: Resection or prosthesis?","volume":"47","author":"Marco","year":"2016","journal-title":"Injury"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1302\/0301-620X.100B11.BJJ-2018-0293.R1","article-title":"Radial head resection versus prosthetic arthroplasty in terrible triad injury: A retrospective comparative cohort study: A retrospective comparative cohort study","volume":"100","author":"Mazhar","year":"2018","journal-title":"Bone Joint J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.3889\/oamjms.2019.305","article-title":"Functional Outcome of Elbow Kinematics in Radial Head Excision Versus Radial Head Replacement: A Comparative Study","volume":"7","author":"Singh","year":"2019","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1016\/j.injury.2018.11.056","article-title":"Surgical treatment of radial head isolated Mason III fractures","volume":"50","author":"Strigini","year":"2019","journal-title":"Injury"},{"key":"ref_23","first-page":"359","article-title":"Comparison of the functional results of radial head resection and prosthesis for irreparable mason type-III fracture","volume":"24","author":"Aslan","year":"2018","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.otsr.2016.10.017","article-title":"Mason type III radial head fractures treated by anatomic radial head arthroplasty: Is. this a safe treatment option?","volume":"103","author":"Tarallo","year":"2017","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_25","first-page":"382","article-title":"Long term results after bipolar radial head arthroplasty","volume":"82","author":"Gielen","year":"2016","journal-title":"Acta Orthop. Belg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"527","DOI":"10.2106\/JBJS.15.00128","article-title":"Radial Head Fractures Treated with Modular Metallic Radial Head Replacement: Outcomes at a Mean Follow-up of Eight Years","volume":"98","author":"Marsh","year":"2016","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s10195-018-0499-6","article-title":"Pyrocarbon arthroplasty in acute unreconstructable radial head fractures: Mid-term to long term results","volume":"19","author":"Lajara","year":"2018","journal-title":"J. Orthop. Traumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"884","DOI":"10.31729\/jnma.7828","article-title":"Radial Head Arthroplasty among Patients with Radial Head Fracture in a Tertiary Care Centre: A Descriptive Cross-sectional Study","volume":"60","author":"Kandel","year":"2022","journal-title":"JNMA J. Nepal. Med. Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s00590-020-02774-4","article-title":"Acute radial head replacement with bipolar prostheses: Midterm results","volume":"31","author":"Nosenzo","year":"2021","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_30","first-page":"6327","article-title":"Comminuted radial head fractures treated by the Acumed anatomic radial head system","volume":"8","author":"Mou","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"183","DOI":"10.5397\/cise.2020.00325","article-title":"Short- to mid-term outcomes of radial head replacement for complex radial head fractures","volume":"23","author":"Baek","year":"2020","journal-title":"Clin. Shoulder Elb."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jse.2010.09.005","article-title":"Resection arthroplasty for radial head fractures: Long-term follow-up","volume":"20","author":"Iftimie","year":"2011","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"558","DOI":"10.2106\/JBJS.I.00332","article-title":"Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old","volume":"92","author":"Barco","year":"2010","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_34","first-page":"143","article-title":"The long-term outcome of open reduction and internal fixation of stable displaced isolated partial articular fractures of the radial head","volume":"67","author":"Lindenhovius","year":"2009","journal-title":"J. Trauma"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.3928\/01477447-20131021-15","article-title":"Resection arthroplasty for Mason type III radial head fractures yield good clinical but poor radiological results in the long term","volume":"36","author":"Yalcinkaya","year":"2013","journal-title":"Orthopedics"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"323","DOI":"10.4103\/0019-5413.114907","article-title":"Surgical management of Mason type III radial head fractures","volume":"47","author":"Miller","year":"2013","journal-title":"Indian J. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.otsr.2015.06.015","article-title":"Prosthesis replacement in Mason III radial head fractures: A meta-analysis","volume":"101","author":"Dou","year":"2015","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1016\/j.injury.2013.04.003","article-title":"Clinical results after different operative treatment methods of radial head and neck fractures: A systematic review and meta-analysis of clinical outcome","volume":"44","author":"Zwingmann","year":"2013","journal-title":"Injury"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1471-2474-4-11","article-title":"The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery","volume":"16","author":"Gummesson","year":"2003","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"30","DOI":"10.2519\/jospt.2014.4893","article-title":"Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH)","volume":"44","author":"Franchignoni","year":"2014","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"174S","DOI":"10.1016\/j.jse.2004.09.031","article-title":"Stability of the elbow: Osseous constraints","volume":"14","author":"Morrey","year":"2005","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.injury.2006.04.125","article-title":"Radial head fracture in the medial collateral ligament deficient elbow; biomechanical comparison of fixation, replacement and excision in human cadavers","volume":"37","author":"Charalambous","year":"2006","journal-title":"Injury"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.2106\/00004623-200408000-00018","article-title":"The effect of radial head excision and arthroplasty on elbow kinematics and stability","volume":"86","author":"Beingessner","year":"2004","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1302\/0301-620X.91B11.21957","article-title":"Mason type IV fractures of the elbow: A 14- to 46-year follow-up study","volume":"91","author":"Herbertsson","year":"2009","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"102674","DOI":"10.1016\/j.jflm.2024.102674","article-title":"Comparative study on informed consent regulation in healthcare among Italy, France, United Kingdom, Nordic Countries, Germany, and Spain","volume":"103","author":"Bolcato","year":"2024","journal-title":"Med. J. Forensic Leg. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1773\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:48:18Z","timestamp":1760028498000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,6]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051773"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051773","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,6]]}}}