Table 2.
Summary of reviewed studies.
| Study | Schmittenbecher et al. | Tan and Mahadev | Zimmerman et al. | Basmajian et al. | De Mattos et al. | Guitterez- de la Iglesia et al. |
|---|---|---|---|---|---|---|
| Journal/Year published | JPO 2005 | JPO 2011 | JBJS(Am) 2013 | JPO B 2014 | JPO 2016 | JPO 2017 |
| Design | Prospective cohort | Retrospective cohort | Retrospective cohort | Retrospective cohort | Retrospective cohort | Retrospective cohort |
| Patients analysed (considered) | 66 (94) | 108 | 140 (151) | 78 | 193; 307 (756)a | 51 |
| Key selection criteria | Inclusion: open physis of radial head | NR | Exclusion: Treated by manipulation outside Operation Theatre; Cognitive impairment; Radial head dysplasias | Exclusion: Age <3 or >15; Not followed till clinical/radiographic union | Inclusion: any open physes around elbow Exclusion: inadequate radiographic/follow-up data |
Inclusion: >30° angulation/50% displacement (Judet 3+) Exclusion: Follow-up <6 m; Associated injuries |
| Mean age (years)/Gender mix (% female) | 8.6 (1.8–14.3) NR |
8.7 (2–14) 46% |
8.4 ( ±2.9) 60% |
7.8 (3–15) 55% |
8.4 (1.3–16.1)a NR |
8 (3–15) |
| Mean follow-up (months) | <5 (Gr 1/2); >6 (Gr 3/4) | 32.4 (12–60) | 13.3 ( ±2) | 4.4 (0.75–28) | Op:2.5 (0.3–39.8) Non-op:6.75 (0.8–39) | 14 (8–39) |
| Fracture Severity grades | Modified Judet | Modified Judet | O’Brien; Exact an-gulation/translation | Judet | O’Brien | Modified Judet |
| Outcome scales/measures | Metaizeau | Tibone | Defined Successful/Unsuccessful | Tibone | Leung/Peterson | Metaizeau; Mayo Elbow Performance Score |
| Proportion with lower fracture grades/non-op Rx | 55%/35% | 78%/87% | 23% of those Rx in OT | 35%/44% | NR/87% | Excluded |
| Outcomesb in lower fracture gradesc | 100% (36/36) | 100% (85/85) | Not reported results by grade | 81% (22/27) | Not reported results by grade | Excluded |
| Outcomes in higher fracture gradesd | 77% (23/30) | 83% (19/23) (Gr 3–88%; Gr 4–70%) | Not reported results by grade | 56% (26/45) | Not reported results by grade | 88% (45/51) with Metaizeau (Gr 3–95%, 4a- 88%, 4b- 77%); 100% using MEPS |
| Outcomes in non-operative treatment | 100% (40/40) | 100% (94/94) | NR | 83% (29/35) | 89% (124/139) | NA |
| Outcomes in patients with casting alone | 100% (36/36) | 100% (86/86) | NR | 89% (17/19) | NR | NA |
| Outcomes in Closed Reduction (CR) +cast | 100% (4/4) | 100% (8/8) | NR | 75% (12/16) | NR | 85% (6/7) |
| Proportion of CR + cast (of those going to theatre) | 36% (8/22) | NR | 42% (63/151) | NR | NR | NR |
| Proportion needing surgery | 39% (26/66) | 13% (14/108) | 58% (88/151) of those going to theatre | 55% (43/78) | 13% (100/756) | Gr3- 71% 4a- 94% 4b- 100% |
| Proportion needing open surgery (of all patients needing operative treatment) | 17% (5/30) | 50% (7/14) | 53% (46/88) | 40% (17/43) | 40% (27/68) | 39% (17/44) Gr3-7% Gr 4a-38% Gr 4b-85% |
| Outcomes in those needing surgery | 73% (19/26) | 71% (10/14) | NR | 58% (25/43) | 73.5% (39/53) | 88% (39/44) |
| Outcomes in percutaneous reduction + fixation | 81% (17/21) | 86% (6/7) | NR | 73% (19/26) | NR | 93% (25/27) |
| Outcomes in those needing OR | 40% (2/5) | 57% (4/7) | NR | 35% (6/17) | NR | 82% (14/17) |
| Incidence of associated injuries | 39% (26/66) (Gr 1/2–33%; Gr 3/4–47%) |
19% (21/108) | 46% (70/151) | 37% (29/78) | Operatively treated cohort- 34% (23/68) | Excluded |
| Incidence of Complications/Common complications reported | NR | 21% (25/118) Cubitus Valgus- 12% |
27% (35/131) HO- 20% |
36% (28/78) Stiffness- 31% |
4.6% (14/307) Op-12% Non-op-3% |
NR Radial head overgrowth-31% Malunion- 20% |
| Heterotrophic Ossification | NR | 4.6% (5/108) | 20% (26/131) | 1.3% (1/78) | 1.6% (5/307) Op-2.9% Non-op-1.3% |
NR |
| Avascular Necrosis | NR | 0 | 3% (4/131) | 2.6% (2/78) | 1.3% (4/307) Op-4.4% Non-op-0.4% |
NR |
| Radio-Ulnar Synostosis | NR | 1.8% (2/108) | NR | 2.6% (2/78) | 0.3% (1/307) Op-1.5% |
2% (1/51) |
| Nerve Injury | 1.3% (1/76) | 3.7% (4/108) | 2% (3/131) | 0 | 0.3% (1/307) Non-Op- 0.5% |
2% (1/51) |
| Physeal closure | 6.5% (5/76) Gr3/4–16% |
NR | 3% (4/131) | 0 | 0 | NR |
NR= Not Reported/NA= Not applicable/OT= Operation Theatre/Op = Operatively treated cohort/Non-op = Non operatively treated cohort.
a) Demographic data is from 307 pts; 193 were included for ROM outcome analysis.
b) Proportion of Good/Excellent outcomes according to respective grading system used.
c) Grades 1/2 in Judet classification and 1 in O’Brien classification- Angulation <30°/Translation<50%.
d) Grades 3/4 in Judet classification and 2/3 in O’Brien classification- Angulation >30°/Translation>50%.