Patient-reported outcomes after surgery for isolated radial head fractures: a systematic review

The optimal surgical treatment of displaced isolated radial head fractures remains unclear and patient-reported outcomes have not been comprehensively evaluated. In this systematic review, we aimed to compare patient-reported pain, function, and return to work outcomes following open reduction internal fixation (ORIF), radial head excision, and radial head arthroplasty (RHA) in patients with isolated radial head fractures. Four electronic databases were searched for the period from January 2000 to August 2023 to identify studies comparing surgical management interventions for isolated radial head fractures. Standard methods were used for title, abstract and full-text screening and data extraction, applying PRISMA 2020 guidelines. Risk of bias was assessed using standardised checklists. Eleven studies were eligible for inclusion. The mean age of participants across the studies ranged from 36 to 65 years, with almost equal gender distribution across 434 participants. Ten studies showed a high risk of bias due to methodological concerns. Follow-up periods ranged from 12 to 84 months post-operatively. Across the included studies, 179 participants (41%) underwent RHA, 139 (32%) underwent ORIF and 116 (27%) underwent excision arthroplasty. Seven studies included patient-reported functional outcomes with relatively better function for ORIF and RHA than excision arthroplasty, eight studies reported patient-reported pain outcomes with similar pain scores across the groups and only one study reported a return to work outcome showing no difference between groups. Significant variation in comparator groups and outcome instruments precluded meta-analysis. This review demonstrates the paucity of high-quality evidence on patient-reported outcomes after surgical management of isolated radial head fractures. There is currently no evidence to indicate any surgical treatment modality is superior with regard to patient-reported outcomes, given the limited number of studies, substantial outcome measure variation and the inherent high risk of bias in existing studies.