Plates versus headless screws for fixation of Mason Type 3 radial head fractures: A systematic review

In this review, we discuss the clinical outcomes of plates and headless screws (HSs) for Mason Type 3 radial head fractures to determine the superior approach.

A comprehensive literature search was conducted across multiple databases for studies on internal fixation of Mason Type 3 radial head fractures, covering publications from inception to December 2024. Literature was screened, and data were extracted according to predefined inclusion criteria. The quality of randomized-controlled trials (RCTs) was assessed using the Cochrane Handbook for Systematic Reviews of Interventions, while the Methodological Index for Non-Randomized Studies (MINORS) recommended by the Cochrane Collaboration was used for non-RCT studies. Systematic review was performed using RevMan version 5.1 software provided by the Cochrane Collaboration.

A total of five studies were included in the systematic review, comparing 89 cases treated with plate fixation and 136 cases treated with HS fixation. The systematic review revealed that plate fixation increased the time to bone union (mean difference [MD]=26.89; 95% confidence interval [CI]: 18.84-34.93; p<0.0001) without significant heterogeneity (p=0.51, I²=0%). Plate fixation was also associated with a decrease in the postoperative Mayo Elbow Performance Score (MEPS) (MD=-5.86; 95% CI: -9.11 to -2.61; p=0.0004) with no significant heterogeneity (p=0.34, I²=6%), although the result was not clinically significant. Plate fixation resulted in reduced postoperative pronation (MD=-8.82; 95% CI: -13.02 to -4.63; p=0.0001) and supination (MD=-8.79; 95% CI: -12.09 to -5.49; p=0.0001). No significant differences were found between the two methods in terms of operation time, length of hospital stay, postoperative flexion-extension, flexion, extension, complications, or postoperative Disabilities of the Shoulder, Arm, and Hand (DASH) scores.

The results of our systematic review indicate that HSs offer a faster bone union time and better functional outcomes in terms of pronation and supination, compared to plate fixation. However, the clinical significance of differences in MEPS and DASH scores is questionable, as they still remain below the minimal clinically important difference thresholds. Given the varying fracture configurations, further studies with larger sample sizes are needed to confirm these findings and determine the most clinically relevant treatment approach.