Fratura da Cabeça Radial Folheto

O que você está sentindo

Você provavelmente sentirá dor aguda na parte externa do cotovelo. É aqui que a cabeça do rádio se encontra. A dor frequentemente irradia para baixo pelo antebraço ou para cima em direção ao ombro. Você também pode notar inchaço e equimoses ao redor da articulação. Esses sinais são comuns após uma queda ou impacto direto.

Toda vez que você flexiona ou estende o braço, a dor pode exacerbar. Movimentos de torção geralmente são os mais difíceis. Girar uma maçaneta, usar uma chave de fenda ou levantar uma sacola de compras pode desencadear um pico de desconforto. Você pode ter dificuldade em rotacionar a palma da mão para cima ou para baixo. Tarefas simples, como guardar a camisa dentro da calça ou alcançar as costas para fechar um sutiã, tornam-se desafiadoras. Você pode instintivamente manter o braço próximo ao corpo para protegê-lo.

Descansar o braço sobre um travesseiro geralmente ajuda a aliviar a pressão sobre a articulação. No entanto, manter o cotovelo completamente imóvel por muito tempo pode fazê-lo sentir-se rígido e tenso. Você pode acordar à noite porque a dor está latejante ou porque não consegue encontrar uma posição confortável. Dormir do lado lesionado geralmente não é possível. Mesmo descansar de costas pode doer se o seu braço cair para o lado.

A gravidade dos seus sintomas depende do quanto o osso se deslocou. Se a fratura for estável, você pode conseguir lidar apenas com analgésicos e movimento suave. Se os fragmentos ósseos estiverem deslocados, a dor será mais intensa e constante. Você pode sentir uma sensação de clique ou atrito ao mover o cotovelo. Isso acontece porque os pedaços quebrados estão esfregando uns contra os outros.

É importante permitir que seu cirurgião avalie a extensão da lesão. Eles determinarão se a fratura é simples ou complexa. Isso nos ajuda a decidir se você precisa de cirurgia ou se o tratamento conservador é suficiente. Não tente superar a dor. Ouça o seu corpo e evite atividades que causem desconforto agudo. O cuidado precoce ajuda a prevenir rigidez a longo prazo e garante que seu cotovelo sarre na melhor posição possível.

O que está realmente acontecendo

O seu cotovelo é uma articulação em dobradiça complexa, formada por três ossos que se encontram em uma única articulação. A cabeça do rádio é a parte superior arredondada do seu osso do antebraço, atuando como um amortecedor de impacto e estabilizador do lado do seu cotovelo. Quando você cai sobre a mão estendida, esse pequeno osso frequentemente absorve a maior parte do impacto.

Em uma fratura deslocada, o osso se fratura e sai do lugar. Isso interrompe a superfície lisa que permite a rotação do seu braço. Você pode sentir dor no lado externo do cotovelo porque o alinhamento natural da articulação está comprometido. Os tecidos circundantes, incluindo os ligamentos que atuam como cordas para manter a articulação unida, também podem se romper. Essa combinação de osso fraturado e ligamentos frouxos leva à instabilidade, fazendo com que o cotovelo pareça fraco ou como se fosse ceder.

Se o osso se fragmentar em muitos pedaços, o seu cirurgião deve decidir entre repará-lo ou substituí-lo. Um implante de cabeça do rádio de metal pode restaurar a função de amortecimento de impacto quando o osso está muito danificado para ser reparado. Essa substituição oferece resultados confiáveis para fraturas complexas. Em alguns casos, a remoção precoce do fragmento fraturado permite que 96% dos pacientes alcancem função satisfatória a longo prazo, embora alterações por desgaste possam aparecer em raios-X posteriormente.

A gravidade da sua lesão depende de quantas estruturas estão envolvidas. Fraturas simples geralmente cicatrizam bem com repouso. Lesões mais complexas, nas quais múltiplos ossos e ligamentos estão danificados, exigem planejamento cuidadoso para restaurar a estabilidade. Compreender esses padrões ajuda o seu cirurgião a escolher a abordagem correta para devolver o movimento seguro ao seu cotovelo.

O que podemos fazer a respeito

A abordagem adotada depende da gravidade da sua lesão. O Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, orienta nossos pacientes nessa decisão com base no seu padrão específico de fratura. A maioria das lesões começa com um período de repouso e movimentos suaves. Nosso objetivo é reduzir o inchaço e manter a mobilidade do seu cotovelo sem forçá-lo. Esta fase de autocuidado geralmente dura algumas semanas. A fisioterapia ajuda você a recuperar força e coordenação à medida que o osso começa a cicatrizar. Para muitos pacientes com fraturas estáveis e minimamente deslocadas, este caminho não cirúrgico é tudo o que é necessário.

Se a dor persistir, podemos discutir o manejo médico para ajudá-lo a lidar enquanto a lesão se resolve. Analgésicos ou anti-inflamatórios de venda livre podem controlar o desconforto a curto prazo. Em alguns casos, podemos sugerir uma injeção. Injeções de cortisona reduzem a inflamação e podem proporcionar alívio por várias semanas. Injeções de ácido hialurônico visam lubrificar a articulação, embora as evidências sobre seu uso em fraturas agudas sejam limitadas. Injeções de plasma rico em plaquetas (PRP) usam seus próprios componentes sanguíneos para apoiar a cicatrização, mas os resultados variam. Essas opções não são curas; são ferramentas para ajudá-lo a participar da reabilitação. Revisamos seu progresso regularmente para ver se essas medidas são suficientes ou se etapas adicionais são necessárias.

A cirurgia é considerada quando o tratamento conservador atingiu seu limite ou quando a fratura é complexa demais para cicatrizar com segurança por conta própria. Recomendamos cirurgia para fraturas deslocadas com mais de três fragmentos, ou se o osso estiver fragmentado (cominutiva). Nestes casos, frequentemente substituímos a parte danificada do osso por um implante metálico. Este procedimento é seguro e eficaz para fraturas não reconstruíveis. Para pacientes com instabilidade grave do cotovelo (lesões do tríade terrível), podemos optar por fixar o osso ou substituí-lo, dependendo do que proporciona a articulação mais estável. A substituição da cabeça do rádio oferece resultados funcionais satisfatórios em 96% dos pacientes no acompanhamento a longo prazo. Discutimos essas opções com você para garantir que o plano corresponda às suas necessidades e objetivos de atividade.

O que esperar

O seu prognóstico depende em grande parte da gravidade da fratura e se outras partes do seu cotovelo estão lesionadas. Para fraturas simples e estáveis, o tratamento não cirúrgico geralmente leva a excelentes resultados a longo prazo. Você pode esperar um baixo risco de complicações com essa abordagem. Mesmo que o seu fragmento ósseo esteja ligeiramente deslocado em 2 a 5 mm, a cirurgia geralmente não oferece benefício adicional em relação ao repouso e imobilização.

Se a sua fratura for complexa ou fragmentada, o seu cirurgião pode recomendar a substituição da cabeça do rádio por um implante metálico. Esta opção é segura e eficaz para fraturas que não podem ser reparadas com placas ou parafusos. A maioria dos pacientes com esses implantes alcança bons resultados funcionais. Dados a longo prazo mostram que 96% dos pacientes têm resultados satisfatórios após a remoção ou substituição precoce da cabeça do rádio. No entanto, você deve saber que as alterações de desgaste são comuns nas radiografias após este procedimento. Apesar dessas alterações visíveis, a sua função diária geralmente permanece boa.

A recuperação parece diferente dependendo do seu caminho de tratamento. Com o cuidado conservador, os sintomas geralmente diminuem à medida que o osso cicatriza. Com a cirurgia, você pode experimentar artrite pós-traumática ao longo do tempo. Este é um risco conhecido, mas nem sempre impede que você use bem o seu braço. Para lesões graves que envolvem múltiplas estruturas do cotovelo, a escolha entre remover ou substituir a cabeça do rádio tem um impacto semelhante no seu resultado final.

A maioria das outras lesões encontradas em ressonâncias magnéticas não é sintomática a curto prazo. Você pode não senti-las de forma alguma. O seu cirurgião focará na fratura principal para restaurar a estabilidade. Embora alguns pacientes possam precisar de cirurgia de revisão mais tarde, a maioria encontra a sua recuperação confiável. Nosso objetivo é fornecer-lhe um cotovelo estável que permita o retorno às suas atividades normais. A sua experiência será guiada pela natureza específica da sua lesão e pela forma como ela responde ao plano escolhido.

Quando procurar ajuda médica

Consulte o seu médico de família se tiver dor persistente que não melhora com o repouso, ou se sentir fraqueza e instabilidade no cotovelo. Solicite uma avaliação especializada se o seu cotovelo bloquear ou ceder, ou se os sintomas interferirem no seu sono ou trabalho. A piora súbita da dor também é um motivo para procurar atendimento médico. O diagnóstico atempado é importante, pois o tratamento tardio pode levar a resultados desfavoráveis. O seu cirurgião irá verificar sinais de instabilidade do antebraço, o que requer uma intervenção inicial adequada. O reconhecimento precoce ajuda a evitar complicações e a apoiar melhores resultados a longo prazo para o seu cotovelo.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

There is insufficient evidence to draw definitive conclusions on the optimal treatment of type II-IV radial head fractures [11].
Recommendations for surgical treatment of radial head and neck fractures according to the Mason classification can now be given with the best available evidence [18].
The challenge in the coming years is to perform high-level clinical studies to obtain consensus regarding the most appropriate treatment for comminuted radial head fractures [1].
Radial head replacement is recommended for comminuted fractures, with satisfactory medium- and long-term results [20].
Bipolar-cemented implants show lower revision rates compared to other options in radial head replacement [20].
Radial head implants offer a reliable treatment for complex Mason type III and IV fractures, with good functional and survival outcomes and a low incidence of complications [3].
Clinical outcome studies of metallic radial head arthroplasty systems indicate that head replacement is a reasonable option to offer patients with comminuted radial head fractures and complex elbow trauma [12].
Adequate knowledge of surgical indications, types of implants, and surgical technique are essential for a satisfactory outcome when a radial head prosthesis is used for the treatment of nonreconstructable radial head fractures [17].
The intraoperative decision to fix or replace the radial head is critical to optimize treatment outcomes [49].
Arthroscopic reduction internal fixation (ARIF) is a safe and viable option for treating displaced radial head fractures [23].
For radial head arthroplasties, acute trauma is the most common indication [14].
The Radial Head System is the most commonly used implant for radial head arthroplasties [14].
Treatment of radial head fractures may have an independent effect on outcome in terrible triad injuries (TTI) [30].
Reconstruction of comminuted radial head fractures is recommended in the context of a TTI, provided stable fixation can be achieved [30].
Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures [35].

Anatomy & Pathophysiology

Most fractures of the radial head are stable [19].
Displaced unstable fractures require restoration of radiocapitellar contact via reconstruction or prosthetic replacement to prevent elbow instability [19].
Complex fractures associated with elbow instability require careful selection between open reduction and internal fixation and arthroplasty [38].
The difference in radiographic height between the tip of the coronoid and anterior radial head in the normal elbow averages 5 mm [39].
The ligaments have the most marked influence on stability, particularly when the upper limb is positioned such that valgus and varus gravity loads are applied to the elbow [55].
Treatment is dictated by fracture type, stability, and ligamentous integrity [58].

Classification

Radial head fractures are common and frequently accompanied by associated osseous injuries [2].
The incidence of associated, osseous injuries of the upper limb in radial head fractures is high [15].
Radial head and neck fractures have distinct epidemiological characteristics [13].
Consideration for osteoporosis in a subset of patients with radial head and neck fractures is recommended [13].
Complications of radial head fractures are characteristic to their classification [4].
It is important to determine which structures need to be repaired in isolated displaced type II partial articular radial head fractures to avoid complications that could lead to elbow instability [7].
Conservative management is indicated for type 1 radial head fractures [52].
Open reduction and internal fixation (ORIF) is indicated for type 2 radial head fractures with mechanical block [52].
Arthroplasty or resection is indicated for type 3 radial head fractures, particularly with ligamentous injury [52].
Recommendations for surgical treatment of radial head and neck fractures according to the Mason classification can be given with the best available evidence [18].
The absence of cortical irregularity in the transition zone of the radial head and neck can be used to correctly identify a non-fractured radial head [10].
A computed tomography–based algorithm for the management of radial head and neck fractures is provided by the Proximal and Articular Radial fractures Management (PARMa) classification [33].

Clinical Presentation

Radial head fractures are common injuries [2].
Radial head fractures are frequently accompanied by associated osseous injuries [2].
Injuries concomitant to radial head fractures were present in 11% of patients [6].
The risk for associated injuries increases with age [6].
Associated injuries must be considered carefully when treating radial head fractures [5].
When a radial head fracture is present, the wrist should be carefully examined for a scaphoid fracture [26].
When a scaphoid fracture is present, the wrist should be carefully examined for a radial head fracture [26].
Ultrasound imaging is an effective method for diagnosing occult fractures of the radial head or neck when initial radiograms show only intraarticular effusion [27].
Cortical irregularity in the transition zone of the radial head and neck is a reliable radiographic sign of an occult radial head fracture [10].
The absence of cortical irregularity in the transition zone can be used to correctly identify a non-fractured radial head [10].
Apparently isolated, stable partial fractures of the radial head are infrequently displaced [24].
Observers have moderate disagreement regarding the diagnosis of displacement in apparently isolated, stable partial fractures of the radial head [24].
Displacement of apparently isolated, stable partial fractures of the radial head is likely overdiagnosed [24].
Long-term patient-reported outcomes are excellent following nonoperative management of isolated stable fractures of the radial head or neck [8].
Conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications [16].
In terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations [29].

Investigations

The complications of radial head fractures are characteristic to their classification [4].
Radial head fractures should be viewed as osteoligamentous lesions rather than merely osseous lesions [51].
It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability [7].
When a radial head fracture is present, the wrist should be carefully examined for a scaphoid fracture, and vice versa [26].
Radial head fractures in women aged 50 years are potentially osteoporotic fractures [22].
Subsequent radiographs during nonoperative treatment of isolated radial head or neck fractures were unhelpful and might contribute to overtreatment [9].
Ultrasound imaging proved to be an effective method for diagnosing occult fractures of the radial head or neck when initial radiograms showed only intraarticular effusion [27].
Because apparently isolated, stable partial fractures of the radial head are infrequently displaced and observers have moderate disagreement regarding the diagnosis of displacement, it is likely that displacement is overdiagnosed [24].
There is a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty, validating radiography as the preferred postsurgical modality of imaging [50].
Anatomic radial head replacement has a risk of radiographic technical mistakes that correlate to poorer outcomes [53].
There are significant radiographic differences between two frequently used radial head arthroplasty implants [60].

Treatment

Non-Operative Management

Nonoperative management of isolated stable radial head or neck fractures yields excellent long-term patient-reported outcomes [8].
Most fractures of the radial head are stable and managed non-operatively with good long-term results [19].
Most radial head fractures can be managed nonsurgically with early motion [38].
Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization [41].
ORIF and nonoperative treatment of isolated Mason type II radial head fractures provide comparably satisfactory functional outcomes, without significant differences [54].

Operative Management: Indications and General Considerations

A treatment algorithm for radial head and neck fractures was provided by the Proximal and Articular Radial fractures Management (PARMa) classification [33].
There is insufficient evidence to draw definitive conclusions on optimal treatment of type II-IV radial head fractures [11].

Radial Head Arthroplasty (RHA)

For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant [14].
Adequate knowledge of the surgical indications, types of implants, and surgical technique are essential for a satisfactory outcome when a radial head prosthesis is used for the treatment of nonreconstructable radial head fractures [17].
The management of acute unreconstructable fractures of the radial head in unstable elbow injuries with radial head replacement has a high risk of reoperation, with the peak risk appearing within 1 year after implantation [37].
This study suggests that RHA is the best treatment of choice for efficacy and safety in the treatment of comminuted radial head fracture [42].
Treatment of radial head fractures may have an independent effect on outcome; the authors recommend reconstruction of comminuted radial head fractures in the context of a terrible triad injury (TTI), providing stable fixation can be achieved [30].

Open Reduction and Internal Fixation (ORIF) and Arthroscopic Reduction Internal Fixation (ARIF)

ARIF is a safe and viable option for treating displaced radial head fractures [23].
This study suggests that RHR is the safest choice to minimize postoperative complications and enable patients to perform all daily life activities [42].

Pediatric Radial Neck Fractures

Thirteen percent of patients with radial neck fractures require operative treatment, 21% of which heal with fair or poor outcomes [21].

Complications

Thirteen percent of patients with radial neck fractures require operative treatment [21].
Twenty-one percent of pediatric patients with radial neck fractures who undergo operative treatment heal with fair or poor outcomes [21].
Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck [8].
Bipolar-cemented implants show lower revision rates than other types of radial head replacement [20].
Radial head arthroplasty for fractures has a high potential for reoperation within the first year [25].
Survival rates with uncemented implants remain high at 10 years despite any need for reoperation [25].
Patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups despite any need for reoperation [25].
Long-term outcomes for radial head arthroplasty are satisfactory [31].
There is a high complication and revision rate for monopolar radial head replacement [31].
Implant survival of monopolar radial head replacement is 75.1% at 18 years [31].
The highest annual failure rate for monopolar radial head replacement is observed in the first postoperative year [31].
Midterm outcomes of EVOLVE radial head prosthesis are satisfactory [32].
Associated complication rates for EVOLVE radial head prosthesis are low [32].
Radial head replacement had better elbow function and fewer adverse events than ORIF for Mason type III radial head fractures in the short term [34].
Concomitant elbow fractures or dislocations do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty [36].
Overlengthening of the radial column is a complication of radial head replacement [47].

Recovery

Most radial head fractures are stable and managed non-operatively with good long-term results [19].
Conservative management of isolated Mason type II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications [16].
Subsequent radiographs during nonoperative treatment of isolated radial head or neck fractures are unhelpful and may contribute to overtreatment [9].
Radial head implants offer reliable treatment for complex Mason type III and IV fractures, with good functional and survival outcomes and a low incidence of complications [3].
Bipolar-cemented radial head implants show lower revision rates compared to other types [20].
Radial head replacement had better elbow function and fewer adverse events than open reduction and internal fixation (ORIF) for Mason type III radial head fractures in the short term [34].
Displaced unstable radial head fractures require restoration of radiocapitellar contact via reconstruction or prosthetic replacement to prevent elbow instability [19].
Radial head arthroplasty has a high potential for reoperation within the first year [25].
The highest annual failure rate for monopolar radial head replacement occurs in the first postoperative year [31].
Implant survival for monopolar radial head replacement is 75.1% at 18 years [31].
Survival rates for uncemented radial head implants remain high at 10 years [25].
Patients report excellent Quick Disability of the Arm, Shoulder, and Hand (DASH) scores at long-term follow-ups after radial head arthroplasty, despite any need for reoperation [25].
Midterm outcomes of EVOLVE radial head prostheses are satisfactory with low associated complication rates [32].
Long-term outcomes for radial head arthroplasty are satisfactory, though there is a high complication and revision rate [31].
If impingement symptoms of the radial head develop, secondary resection yields good results [28].
Twenty-one percent of pediatric radial neck fractures treated operatively heal with fair or poor outcomes [21].

Key Evidence

[L5] The challenge in the coming years will be to perform high-level clinical studies to obtain consensus regarding the most appropriate treatment for comminuted radial head fractures. [1] (10.1007/s00264-018-4082-9)
[L4] Radial head fractures are common and frequently accompanied by associated osseous injuries. [2] (10.1016/j.jse.2009.10.015)
[L4] Radial head implants offer a reliable treatment for complex Mason type III and IV fractures, with good functional and survival outcomes and a low incidence of complications. [3] (10.1016/j.jse.2025.05.038)
[L4] The complications of radial head fractures are characteristic to their classification. [4] (10.1016/j.jse.2018.11.047)
[L4] Associated injuries must be considered carefully when treating radial head fractures. [5] (10.1097/01.blo.0000180606.30981.78)
[L4] Injuries concomitant to radial head fractures were present in 11% of patients and the risk for these associated injuries increases with age. [6] (10.1186/s12891-015-0603-5)
[L3] It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. [7] (10.1016/j.jse.2019.07.006)
[L4] Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. [8] (10.2106/jbjs.m.01354)
[L2] Subsequent radiographs during nonoperative treatment of isolated radial head or neck fractures were unhelpful and might contribute to overtreatment. [9] (10.1016/j.jse.2016.03.007)
[Paper] The absence of the cortical irregularity can be used to correctly identify a non-fractured radial head. [10] (10.1007/s00402-016-2496-7)
[L2] There is insufficient evidence to draw definitive conclusions on optimal treatment of type II-IV radial head fractures. [11] (10.1007/s00402-006-0240-4)
[L5] Clinical outcome studies of metallic radial head arthroplasty systems indicate that head replacement is a reasonable option to offer patients with comminuted radial head fractures and complex elbow trauma. [12] (10.1016/j.jhsa.2005.12.005)
[L4] Radial head and neck fractures have distinct epidemiological characteristics, and consideration for osteoporosis in a subset of patients is recommended. [13] (10.1016/j.jhsa.2011.09.034)
[L3] For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. [14] (10.1177/1758573220987843)
[L4] The incidence of associated, osseous injuries of the upper limb in radial head fractures is high. [15] (10.1007/s11751-008-0038-8)
[L1] Based on the current evidence, conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications. [16] (10.1186/s13018-024-05039-6)
[L5] Adequate knowledge of the surgical indications, types of implants, and surgical technique are essential for a satisfactory outcome when a radial head prosthesis is used for the treatment of nonreconstructable radial head fractures. [17] (10.5435/jaaos-22-10-633)
[L1] Recommendations for surgical treatment of radial head and neck fractures according to the Mason classification can now be given with the best available evidence. [18] (10.1016/j.injury.2013.04.003)
[L5] Most fractures of the radial head are stable and managed non-operatively with good long-term results, while displaced unstable fractures require restoration of radiocapitellar contact via reconstruction or prosthetic replacement to prevent elbow instability. [19] (10.1302/0301-620x.95b2.29877)
[L4] Radial head replacement is recommended for comminuted fractures with satisfactory medium- and long-term results, though bipolar-cemented implants show lower revision rates. [20] (10.1016/j.injury.2013.09.019)
[L4] Thirteen percent of patients with radial neck fractures require operative treatment, 21% of which heal with fair or poor outcomes. [21] (10.1097/bpo.0000000000000387)
[L3] This study confirms that radial head fractures in women aged 50 years are potentially osteoporotic fractures. [22] (10.1016/j.jse.2012.03.007)
[L4] ARIF is a safe and viable option for treating displaced radial head fractures. [23] (10.1016/j.xrrt.2024.08.001)
[L4] Because apparently isolated, stable partial fractures of the radial head are infrequently displaced and observers have moderate disagreement regarding the diagnosis of displacement, it is likely that displacement is overdiagnosed. [24] (10.1016/j.jse.2006.10.015)
[L4] Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. [25] (10.1016/j.jhsa.2023.04.020)
[L4] When a radial head fracture is present, the wrist should be carefully examined for a scaphoid fracture, and vice versa. [26] (10.1054/jhsb.2000.0495)
[L3] Ultrasound imaging proved to be an effective method for diagnosing occult fractures of the radial head or neck when initial radiograms showed only intraarticular effusion. [27] (10.1016/j.injury.2015.10.050)
[L3] If impingement symptoms of radial head develop, secondary resection yields good results. [28] (10.1016/j.jse.2011.02.002)
[L3] The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. [29] (10.5397/cise.2022.01368)
[L3] Treatment of radial head fractures may have an independent effect on outcome; the authors recommend reconstruction of comminuted radial head fractures in the context of a TTI, providing stable fixation can be achieved. [30] (10.1302/0301-620x.102b12.bjj-2020-2145)
[L3] Long-term outcomes for radial head arthroplasty are satisfactory; however, there is a high complication and revision rate, resulting in implant survival of 75.1% at 18 years with the highest annual failure rate observed in the first postoperative year. [31] (10.1016/j.jse.2020.11.031)
[L2] Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low. [32] (10.1177/1758573219850111)
[L4] The study also provided a treatment algorithm for radial head and neck fractures. [33] (10.1016/j.jseint.2024.09.031)
[L1] Compared with ORIF, there was some evidence that radial head replacement had better elbow function and fewer adverse events for Mason type III radial head fractures in the short term. [34] (10.1002/14651858.cd008987.pub2)
[L3] Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures. [35] (10.1177/1558944719837691)
[L3] Concomitant elbow fractures or dislocations do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty. [36] (10.1016/j.jse.2017.06.031)
[L4] The management of acute unreconstructable fractures of the radial head in unstable elbow injuries with radial head replacement has a high risk of reoperation, with the peak risk appearing within 1 year after implantation. [37] (10.1097/corr.0000000000000876)
[L5] Most radial head fractures can be managed nonsurgically with early motion, while complex fractures associated with elbow instability require careful selection between open reduction and internal fixation and arthroplasty. [38] (10.5435/00124635-200707000-00003)
[L5] This study described the relationship between the coronoid and radial head, noting that the difference in radiographic height between the tip of the coronoid and anterior radial head in the normal elbow averages 5 mm. [39] (10.1016/j.jse.2021.05.025)
[L5] Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. [41] (10.1530/eor-24-0035)
[L1] This study suggests that RHA is the best treatment of choice for efficacy and safety in the treatment of comminuted radial head fracture, while RHR is the safest choice to minimize postoperative complications and enable patients to perform all daily life activities. [42] (10.1007/s12306-020-00679-3)
[L4] The review aims to shed light into overlengthening as a complication of radial head replacement and to help identify and treat it. [47] (10.1007/s00402-020-03619-9)
[L5] The intraoperative decision to fix or replace the radial head is critical to optimize treatment outcomes. [49] (10.1016/j.hcl.2004.06.003)
[L4] The study shows a positive association between radiographic findings and patient symptoms for postoperative complications after radial head arthroplasty, validating radiography as the preferred postsurgical modality of imaging. [50] (10.2214/ajr.11.7674)
[L5] Radial head fractures should be viewed as osteoligamentous lesions rather than merely osseous lesions. [51] (10.1016/j.hcl.2015.06.003)
[L5] Radial head fractures are common with variable anatomy; treatment depends on fracture type and associated injuries, with conservative management for type 1, ORIF for type 2 with mechanical block, and arthroplasty or resection for type 3, particularly with ligamentous injury. [52] (10.1177/1758573219876921)
[L3] Anatomic radial head replacement has a risk of radiographic technical mistakes that correlate to poorer outcomes. [53] (10.1016/j.jseint.2026.101671)
[L4] ORIF and nonoperative treatment of isolated Mason type II radial head fractures provide comparably satisfactory functional outcomes, without significant differences. [54] (10.1016/j.jse.2020.10.011)
[L5] The ligaments have the most marked influence on stability, particularly when the upper limb is positioned such that valgus and varus gravity loads are applied to the elbow. [55] (10.1016/j.jse.2004.09.034)
[L5] The goals of current management are aimed at restoring normal anatomical and biomechanical function, with treatment dictated by fracture type, stability, and ligamentous integrity. [58] (10.1016/j.hcl.2007.01.009)
[L3] Our study demonstrates significant radiographic differences between two frequently used radial head arthroplasty implants. [60] (10.1097/bot.0000000000000876)

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