Skip to content

Patients › Rehabilitation

Pagpapalit ng Ulo ng Radial

PDF Evidence

Isang protektadong plano ng paggaling pagkatapos ng pagpapalit ng ulo ng radius sa siko gamit ang metal na implant, na nakabase sa maagang protektadong paggalaw ng siko at forearms upang maiwasan ang stiffness, habang ang forearm ay naka-posisyon upang protektahan ang anumang na-ayos na ligaments at ang siko ay nakapahinga sa simpleng sling para sa kaginhawaan.

Illustrasyon ng pagbagsak sa isang nakalatag na kamay, ang karaniwang paraan kung paano nababasag ang radial head.
Ang radial head sa siko ay madalas na masira sa isang pagbagsak patungo sa isang nakalatag na kamay; kapag hindi ito maayos, ito ay papalitan ng metal implant upang panatilihin ang katatagan at galaw ng siko. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay gabay sa iyong paggaling pagkatapos ng radial head replacement sa siko (kung saan ang sira-sirang radial head ay pinalitan ng maliit na metal implant) kay Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong home exercise program, sinundan ng istrukturadong clinical protocol na isinulat para sa iyong hand therapist; dalhin ang pahinang ito o ang PDF nito sa iyong unang therapy visit upang manatiling koordinado ang iyong rehabilitation. Maaaring baguhin ng iyong therapist ang plano depende sa kung paano ang iyong paggaling at eksaktong naayos noong iyong operasyon.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Karaniwang makakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang radial head ay ang bilugang tuktok ng isa sa dalawang buto ng forearms, kung saan ito nagtatagpo sa siko. Kapag ito ay nabasag sa masyadong maraming piraso upang ayusin, ito ay palitan ng isang maliit na metal implant na nagbabalik ng matatag at konggruwenteng siko at isang makinis na axis para sa pag-ikot ng forearm. Karaniwang ginagawa ito bilang bahagi ng pag-aayos ng mas kumplikadong sugat, isang fracture-dislocation na minsan ay tinatawag na "terrible triad", kung saan ang radial head, isang piraso ng coronoid, at ang mga ligaments sa gilid ng siko ay lahat ay nasugatan nang sabay.

Dahil ang implant ay nagbabalik ng katatagan, ang priority ng iyong rehabilitation ay ang maagang protektadong paggalaw upang maiwasan ang stiffness; ang mga siko ay napakadaling maging stiff matapos ang ganitong uri ng sugat, at ang pinakamainam na proteksyon laban dito ay ang pagsisimula ng paggalaw nang maaga. Ang iyong siko ay nakapahinga sa isang simpleng sling para sa kaginhawahan sa pagitan ng mga ehersisyo (hindi isang hinged brace), at ang sling ay tinatanggal para sa iyong mga ehersisyo at paghuhugas.

Dalawang bagay ang humuhubog kung gaano kabilis at gaano kalayo ang iyong paggalaw:

  • Ang anumang mga ligaments na na-repair ay kailangang protektahan. Kung ang ligament sa labas ng siko (ang lateral collateral ligament) ay na-repair, ang forearm ay hawak at ehersisyo na-ikot na palad-pababa (pronated) sa maagang yugto; kung ang ligament sa loob (ang medial collateral ligament) ay na-repair, ito ay hawak palad-pataas (supinated); kung pareho, sa isang neutral na gitnang posisyon. Ang iyong therapist ang magtuturo sa iyo kung alin ang aplikable sa iyo.
  • Ang siko ay kailangang protektahan laban sa sideways (varus) stress at, sa maagang yugto, laban sa buong pagwawasto kung ang siko ay hindi stable. Ito ang dahilan kung bakit ang paggalaw ay binubuksan nang yugon-yugon imbes na sabay-sabay.

Ang paggalaw ay unti-unting pinapalawak, na may pagpapalakas na karaniwang nagsisimula mula sa mga anim na linggo at pagbabalik sa buong aktibidad sa mga tatlong buwan. Ang implant at ang paggaling ay patuloy na nagse-settle sa loob ng ilang buwan, kaya ang mas mabigat na pag-load ay binubuo nang dahan-dahan.

Mga Paalala at Limitasyon

  • Suotin ang simpleng sling para sa kaginhawaan ayon sa utos; hindi ito hinged brace, at tinatanggal ito para sa mga ehersisyo at paghuhugas.
  • Panatilihin ang forearm sa posisyon na ibinigay ng iyong therapist sa mga unang ehersisyo (palma-pababa kung ang labas na ligamento ang na-repair, palma-pataas kung ang loob na ligamento ang na-repair, neutral kung pareho), na nagpoprotekta sa repair.
  • Huwag GAWIN ang sideways (varus) stress sa siko; iwasan ang pagtindig sa siko o pag-ahon ng braso nang walang suporta sa harap ng katawan sa maagang yugto.
  • Huwag GAWIN ang pagsusumikap sa buong pagwawasto ng siko sa maagang yugto kung sinabi sa iyo na unstable ang siko; iwasto lamang sa loob ng iyong pinapayagang range.
  • Huwag GAWIN ang pag-angat, pagtulak, paghila o pagdadala ng bigat sa pamamagitan ng operated na braso hangga't hindi pa pinapayagan (karaniwan sa anim na linggo); panatilihin ang magaan na paggamit ng kamay sa maagang yugto.
  • Panatilihin ang paggalaw ng iyong balikat, pulso, at mga daliri mula sa simula, at huwag GAWIN ang pagmamaneho habang nasa sling ang iyong braso o hindi mo ito kayang kontrolin ang manibela nang ligtas.

Para sa pag-aalaga sa sugat, pamamahala ng pamamaga, at peklat, tingnan ang wound care na gabay ng kumpanya.

Ang iyong mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Simulan lamang ito ayon sa gabay ni Dr. Hirpara at ng iyong hand therapist, at manatili sa loob ng anumang range at forearm position na ibinigay sa iyo. Ang mga maagang ehersisyo ay pinapanatili ang paggalaw ng siko at forearm upang maiwasan ang stiffness nang hindi nagdudulot ng strain sa anumang repair: active-assisted elbow bending at straightening, maingat na forearm rotation sa iyong pinayagang direksyon, at pagpapanatili ng shoulder at kamay na malaya. Ang strengthening at scar care ay kabilang sa mas huling mga yugto at hindi dapat simulan hangga’t hindi ka espesipikong pinapayagan. Itigil ang anumang nagdudulot ng matulis na sakit o pakiramdam na ang siko ay nagbubulag-bulagan.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang yugto-yugto na klinikal na protokol para sa rehabilitasyon pagkatapos ng pagpapalit ng ulo ng radius (radial head arthroplasty), na karaniwang ginagawa para sa isang hindi na-reconstruct na comminuted na fracture ng ulo ng radius, madalas bilang bahagi ng terrible-triad fracture-dislocation. Ang seksyong ito ay dapat ibigay sa hand therapist, at bawat yugto ay nagsisimula sa isang paliwanag sa simpleng wikang Ingles kung ano ang nangyayari. Ang implant ay nagpapanatili ng isang matatag at congruent na radiocapitellar articulation, kaya ang gabay na prinsipyo ay ang maagang protektadong galaw upang maiwasan ang stiffness na karaniwang kinakaharap ng mga siko na ito, habang ang arc at pag-ikot ng forearms ay kontrolado ng integridad ng anumang collateral-ligament at coronoid repairs.

Bago magsimula ang paggamot, suriin ang operation report ng pasyente at ang examination-under-anaesthesia stability assessment, at makipag-ugnayan sa treating surgeon tungkol sa: aling mga collateral ligaments at/ o coronoid ang na-repair, ang stable arc na ipinakita intra-operatively, at ang protektadong pag-ikot ng forearms. Si Dr. Hirpara ay nagpapahinga ng siko sa simpleng sling para sa kaginhawaan (walang hinged brace) at mas pinipili ang accelerated, early-motion approach kung pinapayagan ng stability. Forearm-position rule: LCL repair → exercise/rest in pronation; MCL repair → supination; both → neutral mid-position; iwasan ang varus stress at, kung ang siko ay unstable, iwasan ang terminal extension sa maagang yugto.

Yugto I — maagang protektadong paggalaw (linggo 0 hanggang 2)

Ang unang dalawang linggo ay nagsisimula sa banayad na protektadong paggalaw sa sandaling payagan ng katatagan ng sugat (karaniwan sa loob ng unang linggo) upang maunahan ang pagkakabigkis. Ang braso ay nakapahinga sa simpleng sling para sa kaginhawaan, at tinatanggal ito para sa mga ehersisyo at paglilinis. Ang siko ay gumagalaw sa loob ng ligtas na arkong galaw habang ang forearms ay nakaayos sa protektadong rotasyon depende sa ligamento na na-repair.

Para sa iyong hand therapist:

Edukasyon at mga paalala - I-immobilize sa simpleng sling para sa kaginhawaan (walang hinged brace); tanggalin para sa mga ehersisyo at paghuhugas - Simulan ang active-assisted/active elbow flexion–extension sa loob ng stable arc na ipinakita sa loob ng operasyon; iwasan ang terminal extension kung ang siko ay unstable - Pag-ikot ng forearms sa protektadong posisyon: pronation kung LCL ang na-repair, supination kung MCL ang na-repair, neutral mid-range kung pareho - Walang varus stress sa anumang oras; gawin ang mga ehersisyo sa itaas habang nakahiga kung unstable upang neutralize ang varus at gamitin ang gravity upang i-coapt ang joint - Walang weight-bearing o pagtulak gamit ang operated na braso

Pamamahala - Sugat: mga surgical dressing ayon sa utos; kumpirmahin ang katatagan ng sugat bago simulan ang paggalaw - Oedema: elevation, banad na hand pump, ice kung kinakailangan - Mga ehersisyo: AAROM/active elbow flexion–extension sa loob ng stable arc; forearm pro/sup sa protektadong direksyon habang ang siko ay nasa 90°; buong active shoulder, wrist, hand at grip ROM

Mga pamantayan para sa pag-progres - Pagkatatapos ng sugat; komportableng kontroladong paggalaw sa loob ng protektadong arc

Yugto II — pagpapalawak ng saklaw ng galaw at pag-ikot ng forearms (linggo 2 hanggang 6)

Mula sa mga dalawa hanggang anim na linggo, ang protektadong saklaw ng galaw ay unti-unting pinapalawak patungo sa buong pagtatagilid (full extension) at ang pag-ikot ng forearm ay binubuksan sa parehong direksyon, na may layuning makamit ang buong pronation/supination sa humigit-kumulang walong linggo. Ang pagpapalakas (strengthening) at paglalagay ng bigat (loading) ay patuloy na pinipigilan.

Para sa iyong hand therapist:

Mga Pagsusuri - Aktibo at pasibong pagliko at pagtatagilid ng siko (elbow flexion–extension) at pag-ikot ng forearm; sakit at pamamaga; pagsusuri sa sugat/peklat; mga sintomas ng kawalan ng katatagan (stability)

Edukasyon at mga paalala - Umunlad patungo sa buong pagtatagilid (full extension) ayon sa kakayahan ng katatagan (release ang anumang maagang hadlang sa pagtatagilid nang dahan-dahan) - Umunlad sa pag-ikot ng forearm sa parehong direksyon patungo sa buong saklaw, ngunit manatiling mapagmatyag sa pinag-ayos na ligamento sa maagang yugto ng panahong ito - Patuloy na iwasan ang varus stress at anumang paglalagay ng bigat sa pamamagitan ng braso

Pamamahala - Mga ehersisyo: palawakin ang saklaw ng pagliko at pagtatagilid ng siko patungo sa buong saklaw; umunlad sa pro/sup patungo sa buong ROM (layuning makamit ang buong saklaw sa ~8 linggo); simulan ang pamamahala ng peklat kapag ang sugat ay gumaling na; patuloy na gawin ang ROM ng balikat/kamay/kamay - Ang programa ng paggalaw sa nakahiga (supine) ay nananatiling kapaki-pakinabang kung may alalahanin sa natitirang kawalan ng katatagan

Mga pamantayan para umunlad - Malapit na sa buong saklaw ng galaw na walang sakit; walang mga sintomas ng kawalan ng katatagan; sakit ≤3/10

Yugto III — pagpapalakas at pagbabalik (linggo 6 hanggang 12 at higit pa)

Kapag naibalik na ang galaw at itinuturing na ligtas ang mga pag-aayos (karaniwan sa paligid ng anim na linggo), magsisimula ang pagpapalakas at unti-unting ito ay dadagdagan (simula sa hawak, pagkatapos ay ang mga ehersisyo sa siko at forearms na may resistensya), na may pag-unlad sa mga sumusunod na linggo. Ang pagbabalik sa mas mabigat na aktibidad ay batay sa mga kriteryo, kadalasan sa paligid ng tatlong buwan.

Para sa iyong hand therapist:

Mga Pagsusuri - Lakas ng siko at forearm kumpara sa kabilang panig; tugon sa sakit/pamamaga sa pag-load; functional at work-/sport-specific testing kung angkop

Edukasyon at mga paalala - Simulan ang banayad na resisted strengthening (hawak → resisted elbow flexion–extension at pro/sup) mula sa paligid ng anim na linggo; unti-unting dagdagan ang load - Magpatuloy sa functional at work-specific loading ayon sa kakayahang tanggapin; iwasan ang biglaang mabigat o impact loading sa maagang yugto

Pamamahala - Mga ehersisyo: progressive resisted elbow/forearm strengthening (band → magagawang bigat); grip strengthening; graded functional loading; patuloy na anumang residual mobility work - Mag-ingat at mag-ulat ng patuloy o lumalalang sakit, mechanical symptoms o pagkawala ng galaw (posibleng implant overstuffing/loosening o capitellar wear), at i-refer pabalik sa treating doctor kung huminto ang recovery o may mahinang resulta - Isalang-alang ang discharge kapag functional na ang galaw at halos symmetrical na ang lakas

Mga Kriteryo para sa pagbabalik sa buong aktibidad - Functional na pain-free ROM; halos symmetrical na lakas; kumpiyansa at katatagan ng siko sa ilalim ng load

Pagbabalik sa trabaho at gawain

Ang magaan na paggamit ng kamay sa pang-araw-araw (pagkain, pagsulat, magaan na pag-aalaga sa sarili) ay inirerekomenda mula sa simula, hangga't komportable at hindi ito kasama ang pagtulak, pag-angat, o pagdadala ng bigat sa pamamagitan ng siko. Dahil hindi maaaring magmaneho habang naka-sling ang braso o hindi kayang kontrolin nang ligtas ang manibela, magplano ng tulong sa transportasyon sa mga unang linggo; muling magmamaneho kapag wala nang naka-sling ang braso at kayang kontrolin ang sasakyan, ayon sa pagpapatunay sa inyong review.

Ang pagpapalakas (strengthening) ay karaniwang nagsisimula sa mga anim na linggo at unti-unting pinapalakas. Ang pagbabalik sa mas mabibigat na trabaho, pag-angat, at isports ay karaniwang nangyayari sa mga tatlong buwan, at nakabase sa pagkuha ng buong galaw na walang sakit at sapat, simetriko na lakas kasama ang matatag na siko, na pinahahalagahan ni Dr. Hirpara at ng inyong hand therapist kaysa sa kalendaryo lamang. Ang mas mabibigat na manual na trabaho at contact sport ay sumusunod sa parehong progresyon na batay sa mga kriteryo.

Pagkatapos ng iyong protocol

Ang protocol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika; tingnan ang pamamahala ng post-operative na pananakit, pag-aalaga sa sugat at pamamahala ng peklat. Ang phased na plano sa itaas ay sumasalamin sa publikadong gabay sa rehabilitasyon pagkatapos ng radial head arthroplasty at terrible-triad reconstruction, at ang iyong patuloy na paggaling ay indibidwal na pinamumunuan ni Dr. Hirpara at ng iyong hand therapist ayon sa kung paano umuunlad ang iyong siko at eksaktong kung ano ang na-repair.

Reviewed by Dr Kieran Hirpara · 21 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

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.

Radial Head Replacement — Procedure Outcomes & Post-operative Rehabilitation (Radial Head Arthroplasty for Unreconstructable Fracture / Terrible Triad)

Topic scope: post-operative rehabilitation after radial head arthroplasty (RHA) — replacement of an unreconstructable comminuted radial head with a metallic implant — performed either in isolation or, more commonly, as one component of reconstructing a fracture-dislocation (the "terrible triad": radial head + coronoid + lateral collateral ligament ± medial collateral ligament). The radial head is a key secondary stabiliser of the elbow against valgus and axial (posterolateral rotatory) load, so the implant exists to restore a stable, congruent radiocapitellar articulation and forearm axis — not merely to fill a defect.

Defining principle of the rehab here: the implant restores stability, so the dominant clinical enemy is stiffness, to which these elbows are strongly predisposed. The rehab is therefore an early protected-motion pathway — start moving within days to a week — explicitly gated by the integrity of the collateral-ligament and coronoid repairs done at the same operation. The two deliberate restraints are (1) the forearm rotation position that offloads the repaired ligament (pronation protects a repaired LCL; supination protects a repaired MCL; neutral mid-range when both), and (2) avoidance of varus stress and, where the elbow was unstable, early terminal extension. A simple sling is worn for comfort — not a hinged brace. The single biggest branch point is how much residual instability was demonstrated on examination under anaesthesia, which determines how fast the arc and forearm rotation are released.

A. PROCEDURE OUTCOMES (radial head arthroplasty; repair-vs-replace context)

Metallic RHA is a reliable reconstruction for the unreconstructable radial head, and — critically for rehab — it restores enough stability to permit early motion even in the setting of associated dislocation, provided the ligaments and coronoid are addressed.

  • RHA restores elbow stability and kinematics when the native head is unreconstructable, but ligament repair is required to fully restore stability. Cadaveric work shows radial head excision alters kinematics and stability, arthroplasty restores them in the ligament-intact elbow, and in the ligament-disrupted elbow arthroplasty plus LCL repair is needed to correct varus–valgus laxity [Beingessner et al., J Bone Joint Surg Am 2004, DOI 10.2106/00004623-200408000-00018]. Strong (mechanistic/biomechanical).
  • RHA gives functional, durable ROM in unstable elbow injuries equivalent to stable injuries. A 15-year single-surgeon series (68 patients) found patients with unstable radial head fractures plus dislocation achieved flexion and rotational arcs similar to stable injuries, with no difference in complication rate or implant survivorship — though supination loss was ~10° greater in the unstable group [Lott et al., J Shoulder Elbow Surg 2018, DOI 10.1016/j.jse.2017.10.011]. Moderate (Level II cohort).
  • Long-term monopolar implant survival is good, with stiffness/sizing the main failure modes. A 15-year follow-up of the Acumed anatomical (press-fit, monopolar) implant for Mason III–IV fractures confirms durable function and survival, with the principal complications being joint stiffness, malpositioning and improper sizing [Tarallo et al., J Shoulder Elbow Surg 2026, DOI 10.1016/j.jse.2025.05.038]. Moderate (long-term cohort).
  • Implant failure/revision risk is real, especially with associated instability. In a young active (military) cohort, RHA carried higher implant-failure rates than ORIF (20% vs 2.9%), and dislocation, coronoid fracture and concomitant ligament repair each predicted complications — underscoring that the injury complex, not just the implant, drives outcome [Kusnezov et al., HAND 2017, DOI 10.1177/1558944717715136]. Moderate.
  • Terrible-triad reconstruction aims explicitly to restore stability sufficient for early motion. Comprehensive reviews frame the entire surgical sequence (LCL repair, radial head fix/replace, ± coronoid, ± MCL/fixator) as a means to permit early ROM and pre-empt stiffness, posttraumatic arthrosis and instability [Fahs et al., J Am Acad Orthop Surg 2024, DOI 10.5435/jaaos-d-24-00310]. Moderate–strong (narrative review).

B. REHABILITATION / THERAPY EVIDENCE

The rehab evidence base is built on biomechanics + surgical-series protocols rather than RCTs: there is strong agreement on early protected motion and on forearm-position-based ligament protection, but the exact arc and timing are individualised to intra-operative stability.

  • Early motion is the consensus priority to prevent stiffness. Across operative series and textbook protocols, formal active and active-assisted ROM is begun within the first week once wound stability is confirmed, with splinting between sessions usually discontinued by 2–3 weeks and strengthening from ~6 weeks [Monica & Mudgal, Hand Clin 2010, DOI 10.1016/j.hcl.2010.04.008; Duckworth et al., Clin Orthop Relat Res 2014, DOI 10.1007/s11999-014-3516-y]. Moderate (consensus/series).
  • Motion is gated by stability, with varus stress avoided at all times. Where instability is a concern, an overhead (supine) rehabilitation protocol begun ~10–14 days post-op achieves early motion while gravity coapts the joint and neutralises varus; "a stiff stable elbow is preferred over a loose incongruous one" [Rockwood and Green's Fractures in Adults, 2019]. Moderate (textbook consensus).
  • Forearm rotation is positioned to protect the repaired ligament. Published RHA protocols position and exercise the forearm in pronation when the LCL was repaired, supination when the MCL was repaired, and neutral mid-range when both were repaired, progressing to full rotation as the repair consolidates [single-centre RHA protocol & narrative review, ResearchGate 2018; UVA / Christ Hospital RHA PT protocols — see URLs]. Weak–moderate (protocol consensus).
  • A coronoid fracture treated without fixation does not preclude early motion in selected triads. Where the LCL and radial head are addressed and intra-operative fluoroscopic stability is confirmed, type I–II coronoid fractures can be left unfixed and still rehabilitated with early motion to good ROM and DASH scores [Papatheodorou et al., Clin Orthop Relat Res 2014, DOI 10.1007/s11999-014-3471-7]. Moderate (Level IV series).
  • Restoring radiocapitellar contact (by replacement) is what permits the early-motion pathway in the unstable elbow; conservative or excision pathways are reserved for stable patterns and depend on the same early-mobilisation principle [Charalambous et al., J Shoulder Elbow Surg 2011, DOI 10.1016/j.jse.2011.02.013]. Moderate.

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Therapy focus Strength / load Notes
I — Early protected motion Week 0–2 (often start <1 wk) Simple sling for comfort (no hinged brace); stable-arc only; forearm in ligament-protective rotation; no varus stress Active/active-assisted elbow flexion–extension within the intra-operative stable arc; forearm pro/sup in the protected direction; full shoulder/wrist/hand ROM; supine overhead programme if unstable None Wound stability confirmed before motion; "stiff-stable > loose-incongruous"
II — Arc & rotation progression Week 2–6 Release extension block / forearm rotation gradually as stability allows Progress elbow arc to full extension; open forearm rotation both directions; scar management once healed None Aim full pronation/supination by ~8 weeks; supination is the slowest to recover (~10° residual loss common)
III — Strengthening & return Week 6–12+ Restrictions lifted as repairs consolidate Grip → resisted elbow/forearm strengthening; graded functional and work-specific loading Begin ~6 wk, build gradually Return to heavier work/sport criterion-based ~3 months; watch for overstuffing/loosening/capitellar wear

(Phase windows mirror the precautions in the patient protocol; they are typical, stability-gated guides, not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Repair (ORIF) vs replace (RHA) the radial head. For reconstructable heads, ORIF is generally preferred and no prosthesis equals the native head biomechanically; for unreconstructable comminution (Mason III–IV) or in the unstable/dislocated elbow, RHA is the more reliable option because fixation constructs fail under the higher stresses [Kusnezov et al. 2017; Charalambous et al. 2011; Leigh & Ball, J Shoulder Elbow Surg 2012, DOI 10.1016/j.jse.2012.03.005]. Moderate; selection-dependent.
  2. Terrible-triad early motion vs protected immobilisation. Modern practice favours restoring enough stability (LCL ± radial head ± coronoid ± MCL/fixator) to permit early motion and avoid stiffness; the supine/overhead protocol exists precisely to reconcile early motion with residual instability. The trade-off ("stiff-stable preferred over loose-incongruous") is consensus, not RCT-settled [Rockwood and Green 2019; Fahs et al. 2024]. Moderate (consensus).
  3. Monopolar vs bipolar implants. Both are used; bipolar designs were intended to self-align and tolerate sizing imperfection, while monopolar anatomical implants show good long-term survival. No clear superiority is established, and overstuffing/sizing error harms either design more than the bearing type does [Tarallo et al. 2026; Doornberg et al., J Bone Joint Surg 2007, DOI 10.2106/jbjs.e.01340]. Weak (no head-to-head superiority).
  4. Implant-related complications. Overstuffing the radiocapitellar joint, malsizing and stem loosening cause capitellar erosion/osteopenia, pain and stiffness; capitellar erosion is reported from metal-on-cartilage articulation, and accurate head height/diameter is the key technical guard [Van Riet et al., J Bone Joint Surg 2004, DOI 10.2106/00004623-200405000-00028; Monica & Mudgal 2010]. Rehab cannot fix a malsized implant — persistent loading pain/stiffness warrants surgical review. Moderate.
  5. Supination is the laggard. Across series, forearm supination is the motion most likely to remain mildly deficient (≈10° loss), partly from scarring and partly from MCL-protective early positioning; patients should be counselled accordingly [Lott et al. 2018]. Moderate natural-history.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (biomechanical / mechanistic): RHA restores elbow stability and kinematics only in concert with collateral-ligament repair (varus–valgus laxity corrected by RHA + LCL repair, not RHA alone).
  • MODERATE: functional ROM after RHA in unstable injuries equivalent to stable injuries with good implant survivorship (Level II–IV cohorts); long-term monopolar implant survival with stiffness/sizing as main failure modes; early-motion-to-prevent-stiffness as the governing rehab principle; supine/overhead protocol for the unstable elbow; supination as the slowest-recovering arc.
  • WEAK / CONSENSUS: the specific forearm-position-by-repaired-ligament rehab rule (pronation for LCL, supination for MCL, neutral for both) and the exact phase timings (protocol-derived, stability-gated, not RCT-validated); monopolar-vs-bipolar bearing choice (no proven superiority).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • The Effect of Radial Head Excision and Arthroplasty on Elbow Kinematics and Stability. J Bone Joint Surg Am. 2004. DOI: 10.2106/00004623-200408000-00018
  • Radial Head Arthroplasty. Hand Clin. 2010. DOI: 10.1016/j.hcl.2010.04.008
  • Results after radial head arthroplasty in unstable fractures. J Shoulder Elbow Surg. 2018. DOI: 10.1016/j.jse.2017.10.011
  • Long-term survival of Acumed anatomical radial head implant for Mason type III-IV fractures: a 15-year follow-up. J Shoulder Elbow Surg. 2026. DOI: 10.1016/j.jse.2025.05.038
  • Operative Management of Unstable Radial Head Fractures in a Young Active Population. HAND. 2017. DOI: 10.1177/1558944717715136
  • Management of Elbow Terrible Triad Injuries: A Comprehensive Review and Update. J Am Acad Orthop Surg. 2024. DOI: 10.5435/jaaos-d-24-00310
  • Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed? Clin Orthop Relat Res. 2014. DOI: 10.1007/s11999-014-3471-7
  • Radial Head Replacement for Acute Complex Fractures: What Are the Rate and Risk Factors for Revision or Removal? Clin Orthop Relat Res. 2014. DOI: 10.1007/s11999-014-3516-y
  • Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow. J Shoulder Elbow Surg. 2012. DOI: 10.1016/j.jse.2012.03.005
  • Comminuted radial head fractures: aspects of current management. J Shoulder Elbow Surg. 2011. DOI: 10.1016/j.jse.2011.02.013
  • Radial Head Arthroplasty with a Modular Metal Spacer to Treat Acute Traumatic Elbow Instability. J Bone Joint Surg Am. 2007. DOI: 10.2106/jbjs.e.01340
  • Capitellar Erosion Caused by a Metal Radial Head Prosthesis. J Bone Joint Surg Am. 2004. DOI: 10.2106/00004623-200405000-00028
  • Comparative study of radial head resection and prosthetic replacement in surgical release of stiff elbows. Int Orthop. 2014. DOI: 10.1007/s00264-014-2594-5
  • Rockwood and Green's Fractures in Adults (terrible-triad surgical pitfalls; overhead/early-motion protocol; "stiff-stable preferred"). Wolters Kluwer, 2019.

Radial head replacement rehabilitation literature (URLs)

  • Rehabilitation protocol after radial head arthroplasty — a single-centre experience and narrative review of the literature. ResearchGate (2018). https://www.researchgate.net/publication/326168570
  • University of Virginia, Department of Orthopaedic Surgery — Radial Head Replacement Rehabilitation Guidelines (forearm-position-by-ligament; arc progression). https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2024/09/Radial-head-replacement.pdf
  • The Christ Hospital — Radial Head Replacement Physical Therapy Protocol (Rao). https://www.thechristhospital.com/landingpages/Documents/Rao%20PT%20Protocols/Operative/Elbow/Rao%20Radial%20Head%20Replacement%20r1.pdf
  • Cheshire Arm Clinic — Physiotherapy Protocol for Radial Head Replacement. https://cheshirearmclinic.co.uk/wp-content/uploads/2021/09/Radial-Head-Replacement.pdf
  • Denver Shoulder — Rehabilitation Protocol: Radial Head Replacement. https://www.denvershouldersurgeon.com/pdf/radial-head-replacement-protocol.pdf

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.