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Radial Head Fracture

Radial head fractures — Mason classification, conservative management, and indications for fixation or replacement.

105 citationsUpdated Oct 2026

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Overview

Radial head fractures constitute approximately 5% of all fractures and 33% of all elbow fractures [3]. The majority are undisplaced and do not require operative treatment [5]. Despite this, there is no clear consensus regarding the management of these injuries, and obtaining expert consensus remains challenging [7, 8]. Optimal treatment for type II and III fractures is still debated, with insufficient evidence to draw definitive conclusions for type II-IV fractures [21, 28]. A strong need exists for randomized clinical trials, uniform fracture classification, and standardized outcome measures to resolve these controversies [21]. Future challenges include performing high-level clinical studies to establish consensus for comminuted radial head fractures [1].

Non-operative management is often sufficient, as fracture displacement of 2 to 3 mm is not necessarily an indication for surgical fixation in isolated fractures [88]. Long-term results demonstrate no appreciable advantage of operative treatment over nonoperative care for displaced but stable isolated partial articular fractures [24]. When operative intervention is required, arthroscopic reduction internal fixation (ARIF) is a safe and viable option for displaced fractures [52]. In the context of a terrible triad injury, reconstruction of comminuted radial head fractures is recommended if stable fixation can be achieved [78].

Radial head replacement offers reliable treatment for complex Mason type III and IV fractures, achieving effective radiocapitellar contact and improving stability with satisfactory short- and mid-term results [26, 27]. Medium-term data suggest patients with comminuted fractures do well with replacement, which is recommended for such cases, though bipolar-cemented implants show lower revision rates [6, 86]. For isolated comminuted fractures, the literature remains controversial regarding whether excision or replacement is superior, with studies generally characterized by small sample sizes and low levels of evidence [83]. Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures [152].

Anatomy & Pathophysiology

Epidemiology

Radial head fractures are the most common fractures of the elbow, with an estimated incidence of 2.5 to 2.9 per 10,000 people per year [67]. They account for approximately 5% of all fractures and 33% of all elbow fractures [3], though other sources cite a range of 15–25% for elbow fractures [36] and approximately 20% [15]. Radial head and neck fractures collectively represent one third of all elbow fractures and approximately 1.5%-4% of all adult fractures [91], accounting for 3% of all fractures seen in emergency departments [124]. Approximately 75% of all proximal forearm fractures involve the radial head and/or neck [124]. Population studies report an incidence of 28 radial head fractures per 100,000 population per year, with a combined radial head and neck fracture incidence of 55 per 100,000 population per year [124].

The mean age for radial head fractures is between 40 and 45.9 years [123, 91]. Injury occurs at an average age of 37 years in men and 52 years in women [124], with female patients on average 7 to 16.8 years older than male patients [91]. Once age rises above 50, the number of female patients is significantly larger than male patients [123]. Radial head fractures are more common in women than in men and most frequently occur between the ages of 20 and 60 years [67], with as much as 85% occurring between the third and sixth decade of age [91]. In children, the incidence for radial head and neck fractures is up to 1.3% [91], with radial neck fractures accounting for approximately 1% of all children’s fractures and 5% of pediatric elbow fractures [79].

Bony Anatomy

The radial head is disk-shaped and of greater diameter than the neck, which rotates within the annular ligament [50]. It has a shallow cuplike surface that articulates with the capitellum proximally and the radial notch of the ulna medially [50]. The biceps inserts on the tuberosity of the radial head immediately distal to the neck [50]. The radial head is seated in the lesser sigmoid notch and has contact axially with the capitellum of the distal humerus [36]. It is neither completely round nor completely cylindrical [124]; its non-circular shape permits the proximal-distal pistoning effect of the radius during forearm rotation and guides the supination-pronation arc [124]. The radial head has a slightly elliptical cross section and interdigitates precisely with both the lesser sigmoid notch and the lateral lip of the trochlea, as well as the capitellar articular surface [115].

The radial head has a relatively small nonarticular surface [115]. This nonarticular area can be determined as an arc of roughly 90 degrees with its midpoint directly lateral with the arm in neutral position, with a slightly greater margin anteriorly [115]. The area between the Lister tubercle and the radial styloid on the distal radius has been suggested as a rough guide to the nonarticular safe zone of the radial head [115]. The vascular supply to the radial head is limited and tenuous [115]. Because the entire radial head is covered with articular cartilage, the blood supply to the epiphysis is supplied through the more distal metaphysis [50]. In children, the cartilaginous radial head is resistant to fracture, making fractures of the radial neck more likely than fractures of the head [50]. The secondary ossification center of the proximal radius appears as a small sphere between the third and fifth years of life and fuses with the shaft between the ages of 16 and 18 years [50].

Ligamentous Anatomy & Stability

The radial head plays an important role as a secondary valgus stabilizer of the elbow [15, 36]. Functionally, the radial head is a secondary stabilizer of the elbow, with the primary stabilizers being the MCL and LUCL [124]. The radial head contributes considerably to the neutralization of valgus forces across the elbow, which occur in the axially loaded, fully extended elbow [124]. An intact radial head, or its substitute, can unload an injured MCL, allowing the ligament to heal without formal repair in most instances [124]. The radial head along with the LUCL can prevent posterolateral rotatory instability [124]. The buttressing effect of the radial head prevents the proximal migration of the radius when interosseous membrane injury is present, as seen in Essex-Lopresti–type injuries [124]. The ligaments have the most marked influence on elbow stability, particularly when the upper limb is positioned such that valgus and varus gravity loads are applied to the elbow [114]. Small subtle effects of radial head fracture size on elbow kinematics and stability were seen in both the ligament intact and ligament deficient elbows [103].

Mechanisms of Injury

Radial head fractures typically result from a fall on an outstretched hand with the forearm in pronation, which results in an axial load on the elbow [15]. They are generally caused by longitudinal loading from a fall on an outstretched hand; dislocation of the elbow is another cause [36]. Most radial head fractures occur as the result of low-energy mechanisms such as a trip and fall on an outstretched hand [67]. Sporting activities as well as motor vehicle collisions cause higher energy fractures typically with greater displacement and a higher incidence of concomitant injuries [67]. Injury mechanism is a fall on the outstretched arm with the elbow in pronation and partial flexion, or in a rare case, direct trauma [91]. Fractures of the radial head or neck may occur as a result of a fall onto an outstretched hand, with the elbow in extension and valgus [50]. This valgus extension force may also produce other injuries, including avulsion of the medial epicondyle, rupture of the medial collateral ligament, and fracture of the olecranon, proximal ulna, or lateral condyle [50].

Specific biomechanical forces produce distinct fracture patterns. A valgus load causes impaction of the radial head into the capitellum, commonly with rupture of the MCL [67]. Posterolateral rotatory subluxation of the radial head with respect to the capitellum causes a partial articular shear fracture of the anterior portion of the radial head often with rupture of the LCL [67]. An axial forearm load causes impaction of the radial head into the capitellum with more severe trauma producing a fracture of the coronoid or rupture of the interosseous membrane and distal radioulnar joint ligaments; the so-called Essex–Lopresti injury [67]. Fracture of the radial neck may also occur as a result of dislocation of the elbow [50]. The radial neck may be fractured by impact against the inferior aspect of the capitellum at the time of posterior dislocation or at the time of spontaneous reduction [50]. A radial head fracture may also occur with anterior dislocation of the elbow and produce anterior displacement of the head [50].

Associated Injuries

Radial head fractures can occur in isolation; however, they often are associated with more complex injuries, such as associated elbow fractures, dislocations, and soft-tissue injuries [15]. Of patients with radial head fractures, 30% have other soft-tissue and skeletal injuries, including carpal fractures, distal radioulnar joint (DRUJ), and interosseous membrane disruption, coronoid fractures, Monteggia fracture-dislocations, capitellar fractures, and medial and lateral collateral ligament injuries [15]. Undisplaced and minimally displaced radial head fractures typically occur as isolated injuries while more displaced and comminuted fractures commonly have associated injuries to the collateral ligaments and may have associated fractures of the coronoid, capitellum, or proximal ulna [67]. In high-energy trauma, dislocations of the elbow and/or forearm can also occur [67]. The majority of radial head and neck fractures are minimally displaced and are isolated injuries [67].

Tears of the LCLs and/or MCLs are most commonly associated with radial head fractures [67]. Dislocations of the elbow and fractures of the coronoid, capitellum, olecranon, and proximal ulna are also frequent associations with radial head fractures [67]. Disruption of the interosseous membrane and distal radial ulnar joint ligaments may result in axial instability of the forearm, termed the Essex–Lopresti lesion [67]. Rupture of the interosseous membrane while uncommon is best diagnosed and treated early as late reconstruction is challenging and often unsatisfactory [67]. The incidence of injuries associated with radial head and neck fractures range from 11% to 90%; however, not all these injuries are clinically relevant [123]. Increasing patient age, loss of cortical contact, and comminution are related to a higher incidence of associated injuries [123]. Magnetic resonance imaging (MRI) can detect 60% to 80% of associated ligamentous injuries in radial head fractures [123]. Persistent symptoms in lateral collateral ligament (LCL) injuries are seen in 11% of patients and medial collateral ligament (MCL) injuries in 1.5% of the patients [123].

Posterolateral dislocation of the elbow is seen in 3% to 14% of radial head fractures, leading to the “terrible triad of the elbow” [123]. Ulnar fractures occur in 1.2% to 12% of patients with radial head fractures; however, this includes Monteggia fracture–dislocations, which is a radial head dislocation in combination with an associated fracture of the ulna [123]. Capitellar osteochondral damage occurs from radial head impaction and is seen on MRI 39% to 96% of the time; however, many of these findings are clinically insignificant [123]. Capitellum fractures rarely occur in tandem with radial head fractures with an incidence of 2% [123]. When radioulnar dislocation from an interosseous ligament injury is suspected, bilateral posterior–anterior in neutral rotation and true lateral radiographs of the both wrists should be obtained to rule out injury to the DRUJ [123]. The degree of radial shortening from this injury that is clinically significant ranges from 2 mm to 1 cm in the reported literature [123]. It is generally accepted that shortening greater than 4 mm is clinically significant and a lesser degree of shortening can be treated conservatively [123]. Approximately 50% of radial neck fractures are associated with other injuries to the elbow [50].

Three hundred seventy-eight (3%) scaphoid fractures among the 11,309 proximal radius fractures were identified in a National Trauma Data Bank review [176]. Both age and sex reached statistical significance as risk factors for concomitant scaphoid and radial head injury [176]. There was an incremental increase in risk for concomitant injury with younger age [176]. Subset analysis demonstrated a 10% incidence of concomitant fractures in men aged 18 to 30 years [176]. Posterior dislocations are associated with radial head fractures in 35% to 100% of cases, as well as coronoid fractures in a significant number of cases [153]. The addition of a coronoid fracture, regardless of size, to an elbow dislocation with a radial head fracture substantially increases the chances of acute and chronic instability and posttraumatic elbow arthrosis [109]. The combination of an elbow dislocation, radial head fracture and coronoid fracture is called 'the terrible triad of the elbow' [18]. Severe elbow instability and many post-traumatic complications are associated with this terrible triad [18].

Classification

The Mason classification of radial head fractures is shown in Table 1 [15]. Mason proposed a classification scheme for radial head fractures: Type I is a nondisplaced fracture; type II is a fracture that is displaced, usually involving a single large fragment; type III is a comminuted fracture; and type IV is a fracture associated with an elbow dislocation [36]. The classification of radial head fractures is based on the size, location, and displacement of the fracture fragments [124]. Type I is a nondisplaced or fissure fracture of the articular rim or neck [124]. Type II is a marginal fracture with less than 2 mm of displacement and 25° of angulation [124]. Type III is a comminuted fracture involving the entire head [124]. A fourth type was subsequently added to include any radial head fracture associated with an elbow dislocation [124]. A 2011 study offered a simplified classification based solely on displacement [124].

O’Brien subdivided radial head and neck fractures into three categories based on the degree of angular displacement of the superior articular surface from the horizontal [50]. In type I fractures, the displacement is 30 degrees or less [50]. Type II fractures have between 31 and 60 degrees of angulation [50]. Type III fractures have more than 60 degrees of displacement [50]. Approximately 50% of fractures of the proximal radius involve the physis and 50% are completely within the metaphysis [50]. Fractures that involve the physis may also be classified according to the Salter-Harris classification of physeal injuries [50]. Proximal radial physeal fractures are usually Salter-Harris type II injuries [50]. Younger children may sustain Salter-Harris type I injuries [50]. Salter-Harris type III or IV fractures involving the radial head and articular surface also occur occasionally [50].

Classification

Epidemiology and Demographics

Radial head fractures constitute one-third of all elbow fractures and approximately 1.5%–4% of all adult fractures [91]. The mean age for radial head and neck fractures is between 45 and 45.9 years, with female patients averaging 7 to 16.8 years older than male patients [91]. In children, the incidence of these fractures is up to 1.3% [91]. Due to distinct epidemiological characteristics, consideration for osteoporosis is recommended in a subset of patients [33].

Historical Classification Systems

Speed (1924): The first classification described by Speed distinguished between complete and incomplete fractures of the radial head and neck [150].

Mason (1954): Developed based on 100 radial head fractures treated operatively or non-operatively and re-evaluated after more than 2 years, this is the first widely accepted classification [44]. Type I fractures are non-displaced marginal fissures or fractures [44]. Type II fractures are displaced marginal fractures with separation or impaction [44]. Type III fractures are displaced comminuted fractures involving the entire radial head [44].

Johnston (1962): Johnston added a fourth type to the Mason classification to signify radial head fractures accompanied by dislocation, irrespective of displacement or fragment comminution [51].

Broberg and Morrey (1987): This modification suggests that a partial radial head fracture must be of sufficient size (at least 30% of the articular surface) and displacement (at least 2 mm) to be considered a displaced fracture (Mason type II) [51]. They added a Type IV defined as a radial head fracture combined with elbow dislocation [44].

Hotchkiss (1997): Hotchkiss modified Mason's classification by adding clinical criteria, defining Type II as a displaced fracture of the radial head or neck combined with mechanical blocking of joint motion or with loss of joint congruity [44]. Type III fractures are characterized by comminution, which precludes internal fixation and requires either resection or prosthetic replacement of the radial head [44].

Mayo Clinic: This classification considers all concomitant lesions and describes the radial head fracture as in Mason's classification with letters added to indicate concomitant lesions [44]. Upper case letters indicate a lesion that is treated, while lower case letters indicate a lesion that is untreated [44].

PARMa (Proximal and Articular Radial fractures Management): This is a computed tomography–based algorithm for the management of radial head and neck fractures [89].

Complex Fracture-Dislocations: A comprehensive classification of complex fracture-dislocations of the elbow was created by the authors of [155] and appeared to be reproducible [155].

Limitations and Reliability

The Mason and modified Mason classifications exhibit limitations, notably moderate inter- and intraobserver reliability and inconsistent guidance regarding treatment or prognostic prediction [51]. A specific limitation of the Mason and Broberg-Morrey classifications is their poor intra-observer and inter-observer reproducibility [44]. These classifications fail to consider concomitant lesions, which are present in nearly 80% of multi-fragment fractures, particularly Type III fractures [44]. Contemporary research suggests that Mason's original scheme is limited in its reliability and usefulness [66]. Modifications of the Mason classification, in particular that of Hotchkiss, may better communicate fracture severity and dictate treatment of radial head fractures [66]. There is no clear consensus regarding radial head fracture [8]. Optimal treatment of type II and III radial head fractures is still the subject of debate, and there is a strong need for randomized clinical trials and uniform fracture classification and outcome measures [21].

Imaging and Diagnostic Characterization

3DCT and 3D physical modeling provide more accurate fracture classification and characterization of fractures of the radial head with less proposed variability in treatment [113]. Ninety-three percent of partial radial head fractures will involve the proximal radioulnar joint (PRUJ) [130]. A geometric model developed for PRUJ involvement allows classification of partial radial head fractures, potentially helping surgeons decide on optimal treatment [130]. 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 [23]. The noncircular shape of the radial head allows for an approach to the anatomy of the radial head more closely when designing radial head prostheses [20].

Associated Injuries and Concomitant Lesions

The incidence of associated, osseous injuries of the upper limb in radial head fractures is high [40]. Posterolateral dislocation of the elbow accompanies 3% to 14% of radial head fractures and can occur after a fall on the (nearly) extended arm [18]. Severe elbow instability and many post-traumatic complications are associated with the terrible triad of the elbow [18]. It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability in isolated displaced type II partial articular radial head fractures [17]. The complications of radial head fractures are characteristic to their classification [10].

Clinical Presentation

Epidemiology and Mechanism

Radial head fractures are the most common fractures occurring around the elbow [49], accounting for roughly one-third of all elbow fractures [108]. Radial head and neck fractures specifically represent 15–25% of all elbow injuries [36]. These injuries are common and frequently accompanied by associated osseous injuries [32]. The typical mechanism involves a fall on an outstretched hand with the forearm in pronation, resulting in an axial load on the elbow [15]. This is generally caused by longitudinal loading from a fall on an outstretched hand [36]. In children, fractures of the radial head or neck usually result from a fall onto an outstretched hand with the elbow in extension and valgus [50].

Associated Injuries

Radial head fractures can occur in isolation; however, they are often associated with more complex injuries, such as associated elbow fractures, dislocations, and soft-tissue injuries [15]. Approximately 30% of patients with radial head fractures have other soft-tissue and skeletal injuries [15]. These associated injuries include: * Carpal fractures * Distal radioulnar joint (DRUJ) and interosseous membrane disruption * Coronoid fractures * Monteggia fracture-dislocations * Capitellar fractures * Medial and lateral collateral ligament injuries [15]

Posterolateral dislocation of the elbow accompanies 3% to 14% of radial head fractures [18]. When a radial head fracture is present, the wrist should be carefully examined for a scaphoid fracture [62]. Five patients have been presented with combined fractures of the carpal scaphoid and the ipsilateral radial head [63]. Although most injuries found with MRI in patients with radial head fractures are not symptomatic or of clinical importance in short-term follow-up [12], associated injuries must be considered carefully when treating radial head fractures [34]. The treating physician should be aware of associated injuries and must take these into account when treating patients with radial head fractures [53].

Clinical Examination

Lateral elbow pain and tenderness or limitation in elbow or forearm motion should alert the examiner to the possibility of a radial head fracture [15]. Physical examination includes pain with palpation over the radial head [15]. The surgeon should examine elbow range of motion (ROM) and assess for a block to pronation/supination or flexion/extension [15]. The surgeon should examine the forearm, wrist, and elbow for: * Tenderness along the course of the interosseous membrane (Essex-Lopresti lesion) * Instability of the DRUJ * Pain at the medial side of the elbow (medial collateral ligament [MCL]) * Pain at the lateral side of the elbow (lateral collateral ligament [LCL]) [15]

The patient should be questioned carefully about concomitant wrist, forearm, or shoulder pain [15]. A proportion of radial head and neck fractures are not visible on standard anteroposterior and lateral radiographs of the elbow and are referred to as 'occult' fractures [59]. In patients with occult fractures, there is tenderness over the radial head and anterior displacement of the fat pad by haemarthrosis on a lateral radiograph [59]. It is difficult to distinguish reluctance to move the forearm as a result of pain from a true mechanical block [59]. A few patients with full forearm rotation have palpable crepitation over the radial head with forearm rotation, but it is not clear if this is associated with greater discomfort or impairment in the long-term [59].

Aspiration of the intra-articular hematoma and injection of a local anesthetic can be helpful when assessing mechanical blocks to motion [15]. Aspiration of the haemarthrosis has been proposed to relieve pain and determine whether there is a block to movement that might merit operative treatment [59]. A study of 16 non-displaced radial head fractures found that aspiration reduced articular pressure and provided pain relief (from 5.5 to 2.5 on a 10-point visual analogue scale) [59]. A recent randomised trial found no significant differences in function or pain between patients treated with aspiration only or aspiration alongside injection of local anaesthetic [59].

Imaging

AP and lateral radiographs of the elbow are routinely obtained [15]. Nondisplaced fractures of the radial head may not be visible on radiographs; however, they may be diagnosed by elevation of the anterior and posterior fat pads (the sail sign) by an intra-articular hemarthrosis [15]. The fat pad sign is usually present on the lateral projection [36]. The radiocapitellar view is accomplished by positioning the patient as for a lateral view but angling the tube 45° toward the shoulder [15]. For comminuted fractures, CT can delineate the location, number, and size of the fragments and is rapidly emerging as a standard imaging method for more complicated radial head fractures [15]. High-resolution CT should be considered for patients with Mason II radial head fractures to appropriately indicate treatment options [69]. 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 [71]. The absence of the cortical irregularity in the transition zone of the radial head and neck can be used to correctly identify a non-fractured radial head [23]. 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 [54]. Subsequent radiographs during nonoperative treatment of isolated radial head or neck fractures were unhelpful and might contribute to overtreatment [22].

Investigations

Mechanism and Associated Injuries: The presence of a radial head fracture mandates a careful examination of the wrist for a scaphoid fracture, and vice versa [62]. The treating physician must identify and account for associated injuries, as determining which structures require repair is critical to avoiding complications that could lead to elbow instability [53, 17].

Clinical Examination: If a patient cannot tolerate a range of motion examination, aspiration of the hematoma, with or without local anesthetic, provides immediate pain relief and improves the quality of the physical examination [90].

Plain radiography: AP and lateral radiographs of the elbow are routinely obtained for radial head fractures [15]. Nondisplaced fractures may be radiographically occult but can be diagnosed by the elevation of the anterior and posterior fat pads, known as the sail sign, caused by intra-articular hemarthrosis [15]. The fat pad sign is usually present on the lateral projection and indicates fluid within the elbow joint, which in the acute setting is most commonly blood from a fracture [36].

Computed Tomography (CT): CT scans are useful to rule out subtle but important coronoid fractures that may necessitate operative intervention in the setting of radial head fracture with associated ulnar-humeral dislocation [76]. In terrible triad injuries, the imaging appearance of radial head fractures on two-dimensional computed tomography has no measurable influence on treatment recommendations [74]. However, three-dimensional analysis of fracture location findings can affect the approach and planning of internal fixation for the radial head fracture [73].

Magnetic Resonance Imaging (MRI): MRI can be helpful in distinguishing congenital radial head dislocation from a traumatic dislocation, where the radial head generally remains intra-capsular in congenital cases whereas it usually tears through the elbow joint capsule in traumatic cases [68].

Arthroscopy: Elbow arthroscopy has significant diagnostic value in radial head fractures when compared to standard radiological imaging and has revealed concomitant injuries even in patients with uneventful MRI/CT [134].

Post-operative Imaging: 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 [160]. Anatomic radial head replacement carries a risk of radiographic technical mistakes that correlate to poorer outcomes [163].

Treatment

Non-Operative

Nonsurgical management is indicated for nondisplaced or minimally displaced radial head fractures (less than 3 mm displacement) provided there is no block to elbow flexion or forearm rotation [15, 90, 92]. Long-term patient-reported outcomes for isolated stable fractures treated nonoperatively are excellent, with most patients achieving good to excellent forearm range of motion and showing no signs of posttraumatic arthritis [19, 90]. Initial immobilization in a sling for comfort is recommended for a short period, typically 7 to 10 days, followed by early range-of-motion exercises [15, 90]. A prospective randomized controlled trial of 180 patients demonstrated that immobilization for only 2 days with a sling followed by active mobilization yielded superior results in motion, strength, and functional outcomes compared with immediate mobilization or 8 days of immobilization [151]. Immobilization in a flexion cast should be avoided, as it results in significantly reduced range of movement compared with extension [116]. Aspiration of a hematoma, with or without local anesthetic, can provide immediate pain relief and facilitate physical examination if the patient cannot tolerate range-of-motion testing [90]; however, a recent randomized trial found no significant differences in function or pain between aspiration alone and aspiration with local anesthetic injection [59]. Conservative management of isolated Mason II fractures yields favorable outcomes with low complication rates, and nonoperatively treated adults show similar functional results at one year compared with operatively treated patients [31, 64]. While one trial was unable to detect significant differences in functional outcomes between surgical and nonsurgical treatment for Mason type-2 fractures [57], conservative treatment does not always yield good results [121].

Operative

Indications: Surgical intervention is indicated for radial head fractures that are significantly displaced, block motion (especially rotation), or are part of complicated injury patterns [15]. Clear indications for open reduction and internal fixation (ORIF) include displaced, noncomminuted fractures that impede rotation or are associated with dislocation [42]. Fractures with greater than 2 mm of displacement and greater than 30% of the articular surface involvement (Mason II) are considered indications for operative fixation, although this threshold remains controversial and unproven [42, 154]. Surgical intervention is specifically indicated when a block to forearm rotation can be attributed to the fracture [151]. Type 3 fractures, which are severely comminuted, typically require surgical intervention to restore elbow and forearm function [151]. Patients with displaced fractures, comminuted fragments, associated elbow instability, or retained intra-articular fragments may benefit from operative intervention [42].

Surgical Approach / Technique: The best candidates for ORIF are young patients with good-quality bone and three or fewer fragments [42, 154]. ORIF using low-profile plates or screws allows stable anatomic reduction while preserving soft tissue attachments [42]. During surgical dissection, care must be taken to preserve all soft tissue attachments if possible [42]. Reduction can be provisionally held with Kirschner wires, and articular impaction or voids can be addressed with bone grafting if needed [42]. Plates should be applied to the anatomic "safe zone," defined as the arc between lines drawn through the radial styloid and the Lister tubercle, which does not articulate with the proximal ulna [15, 42]. Due to high anatomical variability, even precontoured plates require adjustment [42]. Alternatively, headless (1.5 to 2.4 mm) or countersunk headed screws can be inserted in a tripod configuration; this method has shown less stiffness and less need for implant removal relative to plates, though screw fixation may be unstable in the presence of comminution [42]. Mini-fragment screws (2.7 or 2.0 mm) or headless screws with differential pitch (e.g., Herbert screw) should be countersunk to prevent prominence [15]. For complete articular fractures, rigid, low-profile, and often fixed-angle plates placed in the nonarticular portion are required [145]. Reports describe reconstructing widely displaced fractures devoid of soft tissue attachments on the back table before securing them to the remaining head and neck [42].

Implant Selection: Plates and screw fixation are predominantly used, but malpositioned fixation can impede motion [42]. Low-profile tripod screw fixation provides improved results relative to plate fixation; however, screw fixation alone is indicated only for radial neck fractures without comminution [154]. Stable fixation with low-profile plates and/or screws angling into the neck is recommended to prevent fixation failure or nonunion [46]. Avoid plate fixation outside the "safe zone" of the radial head/neck to prevent stiffness [46].

Other Considerations: Attempted fixation when there are more than three fragments is fraught with risks including fragment nonunion, osteonecrosis, fixation failure, and unpredictable forearm motion requiring subsequent hardware removal [42]. Radial head fractures with three or more fragments have a higher incidence of unsatisfactory results with fixation [15]. The management of partial articular fractures tends to be more successful than complete fractures, likely due to improved stability and compromised vascularity in complete radial neck fractures [154]. In one nonrandomized comparative study, complication rates were higher in patients managed with ORIF relative to nonoperative treatment, while clinical outcomes were better in the nonoperatively treated group; randomized clinical trials are needed to resolve this [154]. ORIF of comminuted radial head fractures gained popularity in the 1990s but has fallen out of favor due to technical difficulties, posterior interosseous nerve injury, osteonecrosis, and fixation failure, even with modern site-specific implants [92]. A 2002 study showed that fixation of fractures with more than three fragments, or those with fragment diastasis or severe impaction, resulted in poor outcomes, suggesting radial head arthroplasty as the preferred alternative [92]. A recent meta-analysis of randomized trials confirmed that radial head arthroplasty is preferred over ORIF in these circumstances [92].

Radial Head Arthroplasty: Radial head replacement is a good treatment option for comminuted fractures with more than three fragments, which have a higher rate of failure with surgical fixation [15]. Radial head fracture fixation has a higher failure rate if associated elbow instability is present [15]. For displaced fractures with greater than 3 fragments, radial head replacement is recommended [49]. Radial head arthroplasty is preferred in the setting of unreconstructible comminuted radial head fractures due to the high incidence of associated ligamentous and bony injuries [154]. It may be preferred over tenuous fracture fixation when associated ligament injuries could compromise joint stability if fracture fixation is ineffective [49]. The most commonly used prosthesis is a modular, metallic, smooth stem noncemented design [15]. Prosthetic heads and stems offer a wide variety of height, size, and offset to replicate native radial heads [42]. Acute trauma is the most common indication, with the Radial Head System being the most commonly used implant [37]. Given available evidence, radial head replacement appears to reach better outcomes in patients with Mason type III fractures followed for 5 years or less [9]. RHR for complex radial head fractures yields satisfactory short- to mid-term clinical outcomes, though radiographic complications are relatively high [25]. One study suggests that RHA is the best treatment choice for efficacy and safety in comminuted fractures, while RHR is the safest choice to minimize postoperative complications and enable daily activities [105]. The ideal method of fixation for radial head prostheses remains elusive, but evidence indicates that press-fit prostheses with a rough surface that do not obtain ingrowth or loosen can cause extensive osteolysis [15]. The benefit of routine replacement versus excision has not been evaluated in randomized clinical trials [154].

Radial Head Excision: Radial head excision alone is contraindicated when extensive damage to primary stabilizers is present, including the MCL (valgus instability), coronoid (posterior instability), interosseous membrane (longitudinal instability), or LCL (posterolateral rotatory instability) [15]. The radial head should not be excised in the presence of concomitant ligamentous or bony injury, as this leads to loss of radiocapitellar contact forces and precipitates instability [42]. If ligament instability is ignored, radial head excision will potentiate MCL laxity [92]. Lack of normal radial head-capitellum contact prevents the joint from providing posterolateral rotatory stability in the LUCL-deficient elbow and from absorbing longitudinal loads along the forearm [92]. In the absence of this protective function, interosseous membrane injury is rendered vulnerable to poor healing, potentially resulting in proximal radial migration and ulnar abutment syndrome [92]. Excision should be avoided when ligamentous instability is present [92]. Even with intact collateral ligaments, excision alone alters elbow kinematics and is infrequently performed [42]. A higher incidence of radiographically demonstrated posttraumatic osteoarthritis in the ulnotrochlear joint has been reported after excision, though it is unclear if this results from the excision or initial cartilage impaction; these radiographic changes generally do not correlate with clinical symptoms [92]. Fragment excision can be used for small displaced articular fractures (<25% of the articular diameter) with a block to forearm motion and no elbow instability [42, 92]. If fragment excision is chosen, the surgeon must ensure the radial head defect does not engage the proximal radioulnar joint to prevent pain and stiffness [92]. Excision of large fragments can cause painful clicking and contribute to instability due to loss of concavity–compression stability [154]. Complete radial head excision can be considered for isolated displaced multifragmentary fractures not amenable to internal fixation [42]. Given the high incidence of concomitant soft tissue injuries in comminuted fractures, primary excision is infrequently performed [154]. If excision is planned, a careful examination under anesthesia is mandatory to evaluate for elbow or forearm instability [154]. Intraoperatively, the push–pull test should show no more than 2 to 4 mm of radial movement, and fluoroscopic examination should rule out signs of instability [42].

Technical Precautions: To prevent posterior interosseous nerve injury, maintain the forearm in pronation during the approach, avoid aggressive anterior and medial retraction, and do not dissect distal to the biceps tuberosity [46]. Avoid stripping of articular fragments and maintain periosteal attachment to prevent avascular necrosis [46]. Early motion is recommended to prevent stiffness after ORIF [46]. Removal of hardware can help increase motion [46]. Address all other bony and ligamentous pathology if present to avoid postoperative elbow instability [46]. Have a low threshold to use radial head arthroplasty, especially in the setting of associated elbow instability [46]. Avoid fixation in severely comminuted fractures and in osteoporotic bone [46].

Complications

Associated Injuries

Radial head fractures are frequently accompanied by associated osseous injuries [32]. Concomitant elbow fractures or dislocations do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty [143]. Five patients are presented with combined fractures of the carpal scaphoid and the ipsilateral radial head [63].

Non-Operative Complications

Avascular necrosis of the radial head occurred following closed reduction of a displaced fracture of the neck of the radius with complete 180° rotation of the radial head [96].

Operative Complications

Radial head replacement for complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high [25]. 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 [82]. 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 [61]. Longer-term studies will be required to ascertain whether the apparent benefits of radial head arthroplasty are offset by late complications of arthroplasty, such as loosening [126]. Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low [84]. If impingement symptoms of radial head develop, secondary resection yields good results [72]. Thirteen percent of patients with radial neck fractures require operative treatment, 21% of which heal with fair or poor outcomes [97].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for the resumption of desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: The provided evidence does not detail specific physical therapy phasing, immobilisation duration, weight-bearing or range-of-motion progression schedules, or sling and brace removal timing.

Functional milestones: The provided evidence does not report validated patient-reported outcome measure trajectories or specific benchmark scores for Constant, ASES, or WOMAC scales.

Other Considerations: Long-term functional outcomes following open reduction and internal fixation (ORIF) of Mason type II and III radial head fractures are positive [55]. Clinical outcomes and reoperation rates do not differ between simple fractures (two intra-articular pieces) and comminuted fractures (three or more intra-articular pieces) treated with ORIF [87]. Radial head replacement yields better outcomes in patients with Mason type III fractures followed for five years or less [9]. While radial head replacement for complex fractures provides satisfactory short- to mid-term clinical outcomes, radiographic complications are relatively high [25]. In the short term, radial head prosthesis is a viable option for patients with instability following failed ORIF or radial head resection [30]. Metal radial head implants yield good functional outcomes in recent limited series and personal experience, though longer follow-up is necessary to judge their reliability [131]. Early resection arthroplasty offers satisfactory functional results in 96% of patients at long-term follow-up, despite radiographic degenerative changes present in the great majority of cases [43]. Long-term results following resection for isolated fractures are excellent, with few patients complaining of pain and nearly normal ranges of motion, although pronation and supination are decreased [184]. For terrible triad injuries, outcomes are similar whether the radial head is excised or replaced [183]. Avascular necrosis of the radial head can occur even when a displaced neck fracture with complete 180° rotation is corrected during closed reduction [96]. Uncomplicated displaced or comminuted fractures (Mason type II and III) often have associated ligamentous and/or osteochondral injuries that significantly impact prognosis and treatment protocols [181]. The severity of the radial head fracture correlates with longitudinal forearm injury, evidenced by interosseous membrane tearing [180]. Early recognition of longitudinal radioulnar dissociation aids timely treatment and improved outcomes, with success rates around 80% for acute cases [179].

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)
• [L5] Radial head fractures account for approximately 5% of all fractures and 33% of all elbow fractures. [3] (10.1016/s1058-2746(09)80088-8)
• [L5] The majority of radial head fractures are undisplaced and do not require operative treatment. [5] (10.1016/j.cuor.2006.10.003)
• [L5] Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement. [6] (10.1016/j.jhsa.2012.10.001)
• [L5] Obtaining expert consensus on the treatment of radial head fractures remains challenging. [7] (10.1016/j.jse.2022.10.002)
• [L5] There is no clear consensus regarding radial head fracture. [8] (10.1016/s0266-7681(97)80093-9)
• [L2] Given the available evidence, radial head replacement appeared to reach better outcomes in patients with Mason type III radial head fractures followed 5 years or less. [9] (10.1007/s00590-013-1367-y)
• [L4] The complications of radial head fractures are characteristic to their classification. [10] (10.1016/j.jse.2018.11.047)
• [L2] Most injuries found with MRI in patients with radial head fractures are not symptomatic or of clinical importance in short-term follow-up. [12] (10.1016/j.jse.2011.06.011)
• [L3] It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. [17] (10.1016/j.jse.2019.07.006)
• [L4] [18] (10.5312/wjo.v6.i11.954)
• [L4] Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. [19] (10.2106/jbjs.m.01354)
• [L5] This finding will make it possible to approach the anatomy of the radial head more closely when designing radial head prostheses. [20] (10.1016/s0363-5023(03)00426-x)
• [L4] Optimal treatment of type II and III radial head fractures is still the subject of debate, and there is a strong need for randomized clinical trials and uniform fracture classification and outcome measures. [21] (10.1111/j.1758-5740.2010.00101.x)
• [L2] Subsequent radiographs during nonoperative treatment of isolated radial head or neck fractures were unhelpful and might contribute to overtreatment. [22] (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. [23] (10.1007/s00402-016-2496-7)
• [Abstract] The long-term results of the operative treatment of displaced but stable isolated partial articular fractures of the radial head demonstrate no appreciable advantage over nonoperative treatment. [24] (10.1016/j.jse.2007.02.052)
• [L4] RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high. [25] (10.5397/cise.2020.00325)
• [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. [26] (10.1016/j.jse.2025.05.038)
• [L5] Radial head replacement is a reasonable option for unreconstructable radial head fractures as it achieves effective radiocapitellar contact and improves stability, with satisfactory short- and mid-term results even with combined elbow injuries. [27] (10.5397/cise.2020.00234)
• [L2] There is insufficient evidence to draw definitive conclusions on optimal treatment of type II-IV radial head fractures. [28] (10.1007/s00402-006-0240-4)
• [L4] The ability to generalize outcomes after radial head arthroplasty is limited by the heterogeneity of indications, injury severity, type of implant, and choice of outcome measurements. [29] (10.1016/j.ocl.2013.03.013)
• [L4] Clinically and radiographically, our results are similar to those reported in the literature, and suggest that in the short term, radial head prosthesis is a viable option for patients with instability after failed ORIF or radial head resection for radial head fractures. [30] (10.1080/17453670510045516)
• [L2] Nonoperatively treated adults with an isolated Mason type 2 radial head fracture have similar functional results after 1 year compared with operatively treated patients. [31] (10.1016/j.jse.2021.02.025)
• [L4] Radial head fractures are common and frequently accompanied by associated osseous injuries. [32] (10.1016/j.jse.2009.10.015)
• [L4] Radial head and neck fractures have distinct epidemiological characteristics, and consideration for osteoporosis in a subset of patients is recommended. [33] (10.1016/j.jhsa.2011.09.034)
• [L4] Associated injuries must be considered carefully when treating radial head fractures. [34] (10.1097/01.blo.0000180606.30981.78)
• [L3] For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. [37] (10.1177/1758573220987843)
• [L4] The incidence of associated, osseous injuries of the upper limb in radial head fractures is high. [40] (10.1007/s11751-008-0038-8)
• [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. [41] (10.5435/jaaos-22-10-633)
• [L4] Radial head fractures treated by early resection arthroplasty offer satisfactory functional results in 96% of patients at long-term follow-up, in spite of the radiographic degenerative changes present in the great majority of cases. [43] (10.1016/j.jse.2010.09.005)
• [L4] [44] (10.1016/j.otsr.2015.06.026)
• [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. [47] (10.1016/j.jhsa.2005.12.005)
• [L5] [49] (10.1016/j.jhsa.2008.12.024)
• [L5] [51] (10.1530/eor-24-0035)
• [L4] ARIF is a safe and viable option for treating displaced radial head fractures. [52] (10.1016/j.xrrt.2024.08.001)
• [L4] The treating physician should be aware of the associated injuries and must take these into account when treating patients with radial head fractures. [53] (10.3109/17453674.2010.483988)
• [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. [54] (10.1016/j.jse.2006.10.015)
• [L4] The study results suggest that ORIF of Mason type II and III radial head fractures leads to long-term positive functional outcomes. [55] (10.1016/j.jse.2024.07.022)
• [L1] This trial was unable to detect significant differences in functional outcomes after surgical versus nonsurgical treatment of Mason type-2 radial head fractures in adults. [57] (10.2106/jbjs.21.01483)
• [L5] [59] (10.1302/0301-620x.95b2.29877)
• [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. [61] (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. [62] (10.1054/jhsb.2000.0495)
• [L4] Five patients are presented with combined fractures of the carpal scaphoid and the ipsilateral radial head. [63] (10.1016/s0020-1383(73)80017-8)
• [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. [64] (10.1186/s13018-024-05039-6)
• [L5] Contemporary research suggests that Mason's original scheme is limited in its reliability and usefulness, and that modifications of his classification – in particular that of Hotchkiss – may better communicate fracture severity and dictate treatment of radial head fractures. [66] (10.1007/s11999-012-2319-2)
• [L3] High-resolution CT should be considered for patients with Mason II radial head fractures to appropriately indicate treatment options. [69] (10.1016/j.jseint.2021.04.012)
• [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. [71] (10.1016/j.injury.2015.10.050)
• [L3] If impingement symptoms of radial head develop, secondary resection yields good results. [72] (10.1016/j.jse.2011.02.002)
• [L4] Those findings can affect the approach and planning of the internal fixation of the radial head fracture. [73] (10.1177/1558944716660555cj)
• [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. [74] (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. [78] (10.1302/0301-620x.102b12.bjj-2020-2145)
• [L4] Radial head resection can be recommended in certain comminuted fractures of the radial head. [80] (10.1016/s1058-2746(99)90137-4)
• [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. [82] (10.1016/j.jse.2020.11.031)
• [L5] There is currently no final answer to the question if radial head excision is superior to radial head replacement in the treatment of isolated comminuted radial head fractures, as overall literature is marked with controversy and consists of studies with mainly small sample sizes and of low level of evidence. [83] (10.1016/j.injury.2017.01.004)
• [L2] Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low. [84] (10.1177/1758573219850111)
• [L4] Radial head replacement is recommended for comminuted fractures with satisfactory medium- and long-term results, though bipolar-cemented implants show lower revision rates. [86] (10.1016/j.injury.2013.09.019)
• [L3] In our series, we found no difference in clinical outcome or reoperation rate between simple (2 intra-articular pieces) or comminuted (3 or more intra-articular pieces) radial head fractures treated with ORIF. [87] (10.1016/j.jse.2020.01.031)
• [L2] This retrospective review suggests that fracture displacement of 2 to 3 mm is not necessarily an indication for surgical fixation in isolated fractures of the radial head. [88] (10.1016/j.jse.2013.01.019)
• [L4] The study also provided a treatment algorithm for radial head and neck fractures. [89] (10.1016/j.jseint.2024.09.031)
• [L4] [91] (10.5312/wjo.v4.i2.80)
• [L5] Although this was corrected, avascular necrosis of the radial head occurred. [96] (10.1016/j.jhsb.2006.04.020)
• [L4] Thirteen percent of patients with radial neck fractures require operative treatment, 21% of which heal with fair or poor outcomes. [97] (10.1097/bpo.0000000000000387)
• [L4] Small subtle effects of radial head fracture size on elbow kinematics and stability were seen in both the ligament intact and ligament deficient elbows. [103] (10.1016/j.orthres.2004.06.001)
• [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. [105] (10.1007/s12306-020-00679-3)
• [L4] [108] (10.1097/bot.0000000000001489)
• [Paper] 3DCT and 3D physical modeling provide more accurate fracture classification and characterization of fractures of the radial head with less proposed variability in treatment. [113] (10.1007/s12593-013-0107-1)
• [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. [114] (10.1016/j.jse.2004.09.034)
• [L1] [116] (10.1016/0020-1383(94)90154-6)
• [L4] Conservative treatment of radial head fractures does not always yield good results. [121] (10.1007/s11678-018-0456-2)
• [L3] Longer-term studies will be required to ascertain whether the apparent benefits of radial head arthroplasty are offset by late complications of arthroplasty, such as loosening. [126] (10.1007/s11999-013-3331-x)
• [L3] Ninety-three percent of partial radial head fractures will involve the PRUJ and the geometric model developed allows their classification, potentially helping surgeons decide on optimal treatment. [130] (10.1177/1758573217728492)
• [L4] Metal radial head implants are an attractive solution yielding good functional outcomes in recent limited series and personal experience, but a longer follow-up is necessary to judge their reliability. [131] (10.1016/j.main.2004.11.009)
• [L4] Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging and revealed concomitant injuries even in patients with uneventful MRI/CT. [134] (10.1186/s12891-019-2726-6)
• [L3] Concomitant elbow fractures or dislocations do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty. [143] (10.1016/j.jse.2017.06.031)
• [L5] A complete articular fracture is more challenging and requires the use of rigid, low-profile, and, often, fixed-angle plates placed in the nonarticular portion of the radial head. [145] (10.1097/bte.0b013e318057fb37)
• [L4] [150] (10.1007/s11999-007-0064-8)
• [L3] Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures. [152] (10.1177/1558944719837691)
• [L3] The authors created a comprehensive classification of complex fracture-dislocations of the elbow that appeared to be reproducible and may represent a useful tool for the management of such difficult injuries. [155] (10.1016/j.jse.2011.06.003)
• [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. [160] (10.2214/ajr.11.7674)
• [L3] Anatomic radial head replacement has a risk of radiographic technical mistakes that correlate to poorer outcomes. [163] (10.1016/j.jseint.2026.101671)
• [L4] [176] (10.5435/jaaosglobal-d-19-00055)
• [L5] Early recognition of longitudinal radioulnar dissociation can aid in timely treatment and improved outcomes, with success rates around 80% for acute cases. [179] (10.1016/j.hcl.2007.01.005)
• [L3] The severity of radial head fracture correlates with longitudinal forearm injury evidenced by the presence of interosseous membrane tearing. [180] (10.1007/s11552-013-9561-2)
• [L4] Radial head fractures that initially present as uncomplicated displaced or comminuted (Mason type II and III) often have associated ligamentous and/or osteochondral injuries that may have significant implications on prognosis and appropriate treatment protocols. [181] (10.1016/j.jse.2004.11.003)
• [L3] The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient's radial head was excised or replaced. [183] (10.1302/0301-620x.100b11.bjj-2018-0293.r1)
• [L4] The study documents excellent long-term results following resection of the radial head for isolated fractures, with few patients complaining of pain and ranges of motion nearly normal, though pronation and supination were decreased. [184] (10.2106/00004623-198769030-00010)

See Also

• Radial head arthroplasty
• Ligament Injuries
• Elbow Instability
• Elbow Arthroscopy

References

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