Operative vs. nonoperative treatment in Mason type II fractures: a meta-analysis

It is unclear whether patients benefit from operative treatment in Mason type II radial head fractures. This meta-analysis aims to compare the 2 treatment modalities regarding functional outcomes, complications, and quality of life.

A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted for randomized controlled trials and observational studies comparing operative and nonoperative treatment for Mason type II fractures. Effect estimates were pooled using random-effects models. The primary outcome was elbow function, assessed by the Mayo Elbow Performance Score. Secondary outcomes included range of motion, complications, reinterventions, and quality of life.

Four studies, including 3 observational studies and 1 randomized controlled trial, with a total of 181 patients were included. No significant difference in the Mayo Elbow Performance Score was observed between the operative and nonoperative group (mean difference: 2.67; 95% confidence interval [CI]: -4.48-9.83; I²: 82%). Range of motion of elbow flexion, extension, pronation, and supination showed no significant difference. The nonoperative group showed no increased risk for overall complications at 9.2% vs. 23.4% (odds ratio: 2.66; 95% CI: 0.83-8.49; I²: 25%), or reinterventions at 5.7% vs. 11.7% (odds ratio: 1.29; 95% CI: 0.13-12.30; I²: 57%).

This meta-analysis could not demonstrate a clear advantage of operative treatment for Mason type II fractures in terms of function or complications. However, the long-term effect of surgery in preventing osteoarthritis remains uncertain and should be considered in the treatment decision, as well as the degree of fracture displacement, even within the Mason type II spectrum. Further research focusing on long-term follow-up is needed to make a definitive statement in this regard.