Radial Head Arthroplasty Versus Open Reduction and Internal Fixation for Mason Type III and IV Fractures: A Systematic Review and Meta-Analysis.

The optimal management of Mason type III and IV radial head fractures remains controversial. This systematic review and meta-analysis compared outcomes of radial head arthroplasty (RHA) and open reduction and internal fixation (ORIF). A comprehensive search identified eight cohort studies involving 457 patients. Reported outcomes included range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and complication rates, with data synthesized using pooled effect estimates and heterogeneity assessed through the I² statistic. RHA was associated with significantly improved elbow extension, higher MEPS scores, and lower complication rates compared with ORIF, particularly in cases of severe comminution or Mason type IV fractures, whereas ORIF demonstrated comparable long-term ROM and DASH scores, especially in younger patients with less complex fracture patterns. Overall, RHA appears to provide superior functional outcomes and fewer complications in appropriately selected patients, while ORIF remains a reasonable option for younger individuals with simpler fracture configurations. Treatment decisions should be tailored to fracture severity, patient factors, and surgeon expertise, and further randomized controlled trials are required to establish definitive guidelines for managing complex radial head fractures.