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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)

References

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[25] Radial Head Arthroplasty for Fracture: Implant Survivorship and Outcomes at Mean Follow-Up of 8 Years. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.04.020

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[28] Management of the radial head and linked total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.02.002

[29] Variation in radial head fracture treatment recommendations in terrible triad injuries is not influenced by viewing two-dimensional computed tomography. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2022.01368

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[31] Long-term outcome and survival rate of monopolar radial head replacement. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.11.031

[32] Midterm outcomes of 146 EVOLVE Proline modular radial head prostheses: a systematic review. Shoulder & Elbow. 2019. DOI: 10.1177/1758573219850111

[33] A proposal for computed tomography–based algorithm for the management of radial head and neck fractures: the Proximal and Articular Radial fractures Management (PARMa) classification. JSES International. 2025. DOI: 10.1016/j.jseint.2024.09.031

[34] Surgical interventions for treating radial head fractures in adults. Cochrane Database of Systematic Reviews. 2013. DOI: 10.1002/14651858.cd008987.pub2

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[49] Management of comminuted radial head fractures with replacement arthroplasty. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.06.003

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