Objectives: Radial head fractures make up approximately 3% of all fractures and they are the most common elbow fracture in adults. The treatment for comminuted radial head fracture remains controversial. Currently, the most frequently used treatment for comminuted radial head fracture is fixation, resection or arthroplasty. Therefore, we conducted a systematic review and network meta-analysis to compare the post-operative outcomes among surgical treatment and identify which method is the best for comminuted radial head fractures Mason type III-IV. Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were identified from Medline and Scopus from inception to August 18th, 2017 that reported Mayo elbow performance score (MYPS) and postoperative complications of either treatment. A network meta-analysis was applied to assess treatment outcomes. Probability of being besttreatment was estimated using surface under the cumulative ranking curves (SUCRA). Results: Twelve comparative studies and one RCT (N = 526 patients) met the inclusion criteria. Intervention included ORIF (N = 210 patient), RHA (N = 227 patients) and RHR (N = 152 patients). A network-meta-analysis showed that MYPS of RHA was significantly higher when compared to ORIF and RHR, with the pooled mean MYPS of 7.28 (1.69, 12.86) and -7.32 (-13.21, -1.43) respectively. In terms of complications, RHA and RHR had lower risk with RRs of 0.61 (0.29, 1.31) and 0.54 (0.24, 1.25) when compared to ORIF. The SUCRA probabilities of RHA and RHR were in the first rank with 99.2% in MYPS and 60.6% in complications, respectively. Conclusions: The best surgical treatment option class that have the highest post-operative function scores is radial head arthroplasty followed by ORIF in treatment comminuted radial head fracture Mason type III-IV. While the lowest risk of having complications after surgery is radial head resection followed by radial head arthroplasty. This study suggest radial head arthroplasty and resection that have the first rank for both safety and efficacy outcome should be recommend for treatment comminuted radial head fracture Mason type III-IV. Further research with an increased sample size and a prospective randomized controlled trial study design are required to determine as to which surgical treatment options be the best should be done in the future.