Osteosynthesis versus Arthroplasty in the Management of Radial Head Fractures: A Retrospective Cohort Study

ABSTRACT Background Radial head fractures are among the most common elbow injuries in adults. The choice between osteosynthesis and radial head arthroplasty (RHA) remains controversial, particularly in comminuted or unstable fracture patterns. This study aims to compare functional and radiographic outcomes, complication rates and patient satisfaction following osteosynthesis or arthroplasty in the surgical management of radial head fractures. Methods A retrospective cohort of 35 patients treated surgically for radial head fractures between 2018 and 2022 was analyzed. Fractures were classified using the Mason classification and stratified by complexity. Clinical outcomes included the Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS) for pain, range of motion (ROM) and patient satisfaction. Radiographic follow-up identified complications such as pseudarthrosis and implant migration. Statistical comparisons were performed using non-parametric tests, with significance set at p < 0.05. Results Of 35 patients, 22 (63%) underwent osteosynthesis and 13 (37%) underwent RHA. The osteosynthesis group showed higher mean MEPS (82.7 vs. 74.6) and lower mean VAS (1.52 vs. 2.54) compared to the RHA group, although differences were not statistically significant. Satisfaction scores were similar (mean = 2.0) in both groups. ROM limitations were more frequent in complex fractures but not significantly associated with treatment type. Complication and revision rates were descriptively higher in the RHA group. Conclusion Osteosynthesis may yield favorable functional outcomes and comparable satisfaction relative to arthroplasty, especially in non-complex, reconstructable fractures. In our study the trends favored screw fixation but overall, these findings should be interpreted cautiously, as no statistically significant differences were observed and the analysis is subject to substantial confounding, supporting an exploratory interpretation. Treatment should be individualized and long-term followup is crucial to assess recovery and detect complications. Level of evidence Level IV; Retrospective Case Series