A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials Comparing Treatments for Displaced...

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Evidence-Based Medicine

Background:

• Displaced radial head fractures require careful treatment selection.
• Comparing surgical and non-operative approaches is crucial for optimal patient outcomes.
• Network meta-analysis provides a robust framework for synthesizing evidence from randomized controlled trials.

Purpose of the Study:

• To compare surgical and non-operative management strategies for displaced radial head fractures.
• To evaluate patient-reported outcome measures (PROMs) across different treatment modalities.
• To synthesize evidence from randomized controlled trials (RCTs) using a Bayesian network meta-analysis.

Main Methods:

• Systematic review of Medline, Embase, and Cochrane Library for RCTs up to August 2021.
• Inclusion of studies on isolated, displaced radial head fractures in adults.
• Bayesian network meta-analysis of five RCTs involving 326 patients.

Main Results:

• Radial head arthroplasty (RHA) demonstrated significantly better PROMs than open reduction internal fixation with metal implants (ORIF-M).
• RHA also showed favorable trends over open reduction internal fixation with biodegradable implants (ORIF-B).
• Non-operative management did not show significantly worse outcomes compared to RHA.

Conclusions:

• Radial head arthroplasty (RHA) is associated with superior functional PROMs compared to ORIF-M for displaced radial head fractures.
• Non-operative management presents a viable alternative, with outcomes not significantly inferior to RHA.
• Further research may refine treatment guidelines for these fractures.