Comparison of Radial Head Prosthesis versus Excision in Comminuted Radial Head Fractures: A Retrospective Comparative Study

Introduction: Complex comminuted fractures of the radial head (Mason type III/IV) remain challenging to manage. This study compares functional and clinical outcomes between radial head prosthesis and excision. Materials and Methods: This retrospective study included 40 adult patients who underwent operative management for acute, displaced radial head fractures (Mason Type III or IV) at a single institution between November 2022 and November 2024. A total of 2 years of the patient's medical records, operative reports, and radiographic images were reviewed. Patients were categorized into two treatment groups: Group A (Excision, n = 20) receiving radial head excision and Group B (Replacement, n = 20) treated with metallic radial head replacement arthroplasty. Inclusion criteria required a minimum of 6-month follow-up. Pre-operative data, including patient demographics, injury mechanism, and fracture classification, were collected, and post-operative follow-up data focused on assessing clinical outcomes using the Mayo Elbow performance index (MEPI) and Broberg-Morrey scores, alongside complications. Results: Mean age was 44 years of age with a standard deviation of ±7.4. Operative time (69.85 vs. 50.4 min, P < 0.001) and hospital stay (7.6 vs. 4.95 days, P = 0.0003) were longer for the prosthesis. MEPI and Broberg-Morrey scores were higher in the prosthesis group at all follow-ups (P < 0.05). Instability occurred in 40% of excision cases but none in prosthesis cases. Conclusion: Radial head replacement offers better early functional outcomes and joint stability.