Radial Head Fracture Info In-depth Evidence
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
What you're feeling
You likely felt a sharp pain in the outer part of your elbow, just below the bony bump on the outside of your arm. This often happens after a fall onto an outstretched hand or a sudden impact. You might have heard or felt a snap or pop at the moment of injury.
Your elbow will probably swell up quickly. Bruising may appear on the skin around the joint within the first few days. You will likely find it difficult to bend or straighten your arm. Turning your palm up or down may feel blocked or painful. You might notice a visible deformity if the bone has shifted out of place.
In the first few days, pain is often constant. It can be worse at night when you try to sleep. Simple movements like lifting a cup of tea or opening a door may hurt. You may feel reluctant to move your arm at all. This is your body’s natural response to protect the injured area.
As the initial swelling settles, the pain may become more specific to movement. You might feel a dull ache that comes and goes. If your fracture is stable, you may find that gentle movement feels slightly better than keeping it completely still. However, forcing the arm to move will still cause discomfort.
If the injury is more complex, involving other structures in the elbow or forearm, you might feel instability. This can feel like your arm is giving way or not tracking correctly. You may notice pain radiating down your forearm. These sensations indicate that more than just the bone is affected.
Most patients find that the intense, sharp pain subsides into a manageable ache over the first two to three weeks. Night pain usually improves as you find comfortable sleeping positions. Swelling may persist for several weeks, making the elbow feel tight or stiff. You will likely need to avoid heavy lifting or pushing activities during this time.
Your experience will depend on the type of fracture you have. Simple fractures often feel less severe than complex ones. If you have a comminuted fracture, where the bone is broken into multiple pieces, the initial pain may be more significant. Your surgeon will assess the extent of the injury to guide your recovery.
What's actually happening
Your radial head is the rounded top part of one of the two bones in your forearm. It sits inside your elbow joint, acting like a cushion that helps your arm bend and twist smoothly. When you fracture this bone, you have broken that cushion. This disrupts the smooth movement of your elbow and can make the joint feel unstable or painful.
Think of your elbow like a hinge on a door. The radial head is the pin that keeps the door aligned as it swings open and closed. If that pin is cracked or shattered, the door will wobble, stick, or grind. This is why your arm does not work normally right now. You may find it difficult to lift objects or turn your palm upwards.
In some cases, the break is more than just a simple crack. If the bone is shattered into many pieces, or if it has shifted out of place by more than 2 mm, the joint structure is compromised. This displacement can lead to long-term stiffness or arthritis if not managed correctly. Your surgeon will look closely at how much the bone has moved to decide the best path forward.
Sometimes, the force that broke your radial head also tears the ligaments on the outside of your elbow. These ligaments act like strong bands that hold your joint together. When they are torn, your elbow becomes loose and prone to dislocating. This combination of a broken bone and torn ligaments creates a complex instability that requires careful assessment.
Healing depends on the severity of the injury. For minor, stable fractures, your body can knit the bone back together on its own. The pain and swelling will settle as the bone heals over several weeks. However, if the bone is too shattered to repair, or if the joint remains unstable, surgery may be needed. This might involve replacing the broken bone with a metal implant to restore stability and function.
Early movement is crucial for recovery. Keeping your elbow still for too long can cause the joint to stiffen permanently. Your surgeon will guide you on when to start moving your arm gently to regain range of motion. This balance between protection and movement is key to getting your elbow working well again.
What we can do about it
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. For stable fractures or those with minimal displacement, we often recommend non-surgical care. This involves wearing a sling, splint, or cast to keep the bone still while it heals. We monitor your progress with repeat imaging to ensure the bone stays in the right position. You will begin gentle movement exercises with a physiotherapist as soon as it is safe. Most patients with these types of fractures recover well without needing an operation.
Surgery is recommended from the outset if your fracture is displaced, unstable, or involves multiple fragments. We may suggest replacing the radial head with a metal implant if the bone is too broken to repair. This approach is also considered for complex injuries that affect the stability of your elbow. In some cases, such as when there is significant displacement between 2 mm and 5 mm, we discuss whether surgery offers a clear benefit over conservative care. For severe patterns like terrible triad injuries, we aim to stabilise the joint to prevent long-term instability. We review the evidence with you, noting that 96% of patients achieve satisfactory functional results with radial head replacement in the long term. This helps you make a shared decision about the best path for your specific injury and lifestyle needs.
Both treatment paths share common goals: managing pain, protecting the injury, and restoring movement. In the early weeks, we focus on keeping you comfortable and preventing stiffness. We advise against using local anaesthetic injections for pain relief in undisplaced fractures, as they do not offer additional benefit over simple aspiration. As your healing progresses, we guide you through staged physiotherapy to regain strength and range of motion. We also assess for any other injuries that may have occurred at the same time, such as ligament damage, to ensure your elbow remains stable. Regular follow-ups allow us to adjust your recovery plan based on how your body responds.
Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate.
What to expect
Your recovery path depends on how severe the fracture is. For simple, stable breaks, your surgeon may recommend non-surgical care. You will likely wear a sling or brace for a short period. Long-term outcomes for these cases are excellent. Most patients return to normal daily tasks without significant restriction.
If the bone is broken into multiple pieces or displaced more than 2 mm but less than 5 mm, surgery may not offer extra benefit compared to conservative care. In these cases, your surgeon might still advise rest and gentle movement. For complex fractures that cannot be fixed with screws, your surgeon may recommend replacing the radial head with a metal implant. This is a safe and effective option for unreconstructible breaks.
Healing takes time. Bone typically takes several weeks to knit together. If you have surgery, you will start moving your elbow early to prevent stiffness. Most patients regain good function within weeks to months. For those with complex injuries, the goal is to restore stability. You can expect to return to daily activities as pain allows.
Return to work and sport varies by job demands. Light duties may resume quickly. Heavy manual labour or high-impact sports require more time. Your surgeon will guide you based on your specific healing progress. Most patients achieve satisfactory functional results in the long term.
There are risks to be aware of. Stiffness is common if movement is delayed. In some cases, the bone may heal slowly or in a slightly imperfect position. If you have a metal implant, there is a risk of loosening over many years. Radiographic signs of wear-and-tear arthritis are common after certain procedures, even when function remains good. Neurological complications are rare but possible.
For severe elbow dislocations involving the radial head, treatment is more complex. Your surgeon will address associated ligament injuries to ensure stability. Outcomes are generally similar whether the radial head is removed or replaced in these specific cases. However, revision surgery may be needed if complications arise.
Overall, the majority of patients report good long-term clinical outcomes. You should expect a gradual return to full use of your arm. Patience is key. Follow your surgeon’s advice on activity levels to protect your healing elbow.
When to see someone
Seek urgent care if you have deformity, an open wound, numbness or tingling, or cannot use your arm. These signs may indicate serious damage needing immediate attention. If pain is not settling, or if swelling and movement are not improving week on week as healing progresses, see your GP or ask for a specialist review. Early assessment helps prevent complications like elbow instability. Your surgeon can determine if conservative management or further treatment is needed to support your recovery and restore function safely.
Advanced reading: the deeper science (optional)
This section goes further than you need for your own treatment decisions. A radial head fracture is worth the extra reading because the bone itself is often the least important part of the injury — what determines your result is usually whether anything else in the elbow was damaged at the same time.
The fracture is a marker, not just an injury
The radial head is a stabiliser. It stops the radius sliding up the forearm and it resists the elbow being pushed sideways. So a force large enough to break it is frequently large enough to damage the ligaments and the coronoid too — the combination known as the terrible triad: radial head fracture, coronoid fracture and elbow dislocation.
That is why an isolated, undisplaced radial head fracture and a radial head fracture as part of a triad are entirely different problems with the same name on the X-ray report. The first usually needs early movement and little else. The second is one of the more demanding reconstructions in upper-limb surgery.
Even the surgical approach for the triad is contested. Pooling 866 patients, a combined lateral plus anteromedial approach appeared to offer a favourable balance between functional outcome and complication risk, while purely anterolateral or anteromedial approaches offered advantages in some postoperative measures [1] — a comparison that would not still be open if one route were clearly superior.
Fix it or replace it
Where the head is broken but reconstructable, fixing it preserves your own anatomy. Where it is in too many fragments, replacement is generally preferred over attempting a fixation likely to fail — a failed fixation leaves a stiff, unstable elbow and a harder second operation.
When replacement is chosen, the design debate has been quieter than expected. Comparing monopolar with bipolar radial head prostheses across 591 patients found no significant difference in efficacy or safety, with the authors calling for higher-quality randomised trials [2].
That is a useful thing to know if you are told a particular implant is better. On current evidence the distinction has not been demonstrated.
Why implants get removed — and it is not what you would guess
A meta-analysis of 1,017 radial head arthroplasties found that removal or revision peaked within two years of implantation, and that most removals were performed to manage elbow stiffness and heterotopic ossification rather than loosening of the implant [3].
So the implant usually is not the thing that failed. The elbow around it stiffened, and taking the metal out formed part of treating that. It reframes what "revision surgery" means here, and it explains why the rehabilitation after this operation matters more than the choice of prosthesis.
It also means published revision rates should be read with the follow-up length in mind. A separate review of 1,272 patients concluded the literature does not provide a reliable estimate of the re-operation rate, and recommended a minimum of three years of follow-up with an agreed definition of what counts as a reason for revision [4]. A study reporting twelve months will systematically miss the removals that cluster in the first two years.
The thing to protect is motion
The consistent thread is that the elbow's characteristic failure is stiffness, not instability or implant failure. It is an unforgiving joint: it tolerates immobility badly and loses the last degrees of extension readily. Whatever is done to the bone, the months afterwards are what determine how the arm works.
References for the advanced reading
- Zheng M, Wan W, Liang S. Which is the optimal surgical strategy for the terrible triad of the elbow? A systematic review and meta-analysis. J Orthop Surg Res. 2026;21(1).
- Said E, Ameen M, Sayed AA, Mosallam KH, Ahmed AM, Tammam H. Efficacy and safety of monopolar versus bipolar radial head arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(3):646-55.
- Kachooei AR, Baradaran A, Ebrahimzadeh MH, van Dijk CN, Chen N. The rate of radial head prosthesis removal or revision: a systematic review and meta-analysis. J Hand Surg Am. 2018;43(1):39-53.e1.
- Laumonerie P, Reina N, Kerezoudis P, Declaux S, Tibbo ME, Bonnevialle N, et al. The minimum follow-up required for radial head arthroplasty. Bone Joint J. 2017;99-B(12):1561-70.
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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