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Radial Head Fracture

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

Overview

Radial head fractures present with complications characteristic of their classification, and treatment selection significantly influences clinical outcomes. For isolated stable fractures of the radial head or neck, nonoperative management yields excellent long-term patient-reported outcomes [2]. While fracture displacement of 2 to 3 mm is not necessarily an indication for surgical fixation in isolated fractures, ORIF offers no clinical benefit over nonoperative management for isolated partial articular fractures with displacement between 2 and 5 mm at short-term followup [4, 26].

Radial head arthroplasty is a reliable treatment for complex Mason type III and IV fractures and unreconstructible radial heads, particularly when associated with unstable elbows or forearm injuries [8, 10, 21]. This approach provides satisfactory functional results in 96% of patients at long-term followup, though radiographic degenerative changes are present in the great majority of cases following early resection arthroplasty [5]. In the context of terrible triad injuries, reconstruction is recommended when stable fixation can be achieved, as treatment of the radial head itself is associated with increased reoperation risk [11, 19].

Anatomy & Pathophysiology

Osseous Stability and Fracture Patterns

Disruptions in any forearm structure may lead to instability with consequences at the remaining structures [34]. Detailed knowledge of fracture characteristics and their association with specific patterns of traumatic elbow instability may assist decision making and preoperative planning [32]. Comminuted radial head fractures require assessment for concurrent injuries and specific complications related to each treatment modality [20]. Elbows with Type-IV capitellar fractures or fractures with an ipsilateral radial head fracture have greater flexion contractures at the time of follow-up [44]. Good to excellent outcomes with functional ulnohumeral motion can be achieved following internal fixation of complex capitellar fractures despite greater flexion contractures [44]. Early mobilization is important for the restoration of elbow range of motion and function in Mason Type-III radial head fractures [31].

Ligamentous and Complex Instability

Isolated displaced type II partial articular radial head fractures are correlated with lateral ulnar collateral ligament tears [9]. Understanding relevant anatomy and factors associated with elbow stability allows for the application of a systematic algorithm for treating terrible triad injuries [29]. The anatomic model of terrible triad of the elbow was created by exerting axial compression on an elbow in 15° flexion and maximal pronation [30]. This model was validated using compression speeds of 100 and 10 mm/min [30]. The terrible triad of the elbow is surgically treatable to allow a high functional standard in the short-term and long term [40]. Using a standardized protocol, sufficient elbow stability and good outcomes can be achieved in most terrible triad injuries [41]. In selected terrible triad cases where the elbow is well aligned and fractures are relatively small and minimally displaced after closed reduction with no mechanical block to motion, patients might regain good elbow function without surgery [47]. Trans-olecranon fracture posterior dislocation is a rare injury with unique characteristics involving complex elbow instability [48].

Imaging and Assessment

The coronoid opening angle is a radiographic technique used to assess bone loss in coronoid trauma [27]. The coronoid opening angle can be used alongside 3-dimensional imaging in evaluating elbow injuries [27]. The coronoid opening angle serves as an adjunct in clinical decision making for elbow injuries [27]. Understanding the patterns of traumatic elbow instability helps surgeons counsel and manage patients with these injuries [35].

Outcomes and Complications

The presence of nerve injury predisposes floating elbow injuries to worse clinical outcomes [38]. Intra-articular involvement predisposes floating elbow injuries to worse clinical outcomes [38]. Long-term outcome with surgical management of complex elbow injuries is unknown [42]. Postoperative complications including synostosis and elbow instability may not be as common as previously understood with the Boyd approach [49].

Classification

Radial Head Fracture Phenotypes: Complications of radial head fractures are characteristic to their classification [6]. Radial head and neck fractures have distinct epidemiological characteristics [7], and consideration for osteoporosis is recommended in a subset of patients with radial head and neck fractures [7]. Apparently isolated, stable partial fractures of the radial head are infrequently displaced [15], yet observers have moderate disagreement regarding the diagnosis of displacement in these injuries [15]. Displacement is likely overdiagnosed in apparently isolated, stable partial fractures of the radial head [15].

Fracture Patterns and Mechanisms: Fracture maps demonstrate no association between fracture line distribution and location of displaced partial articular fractures of the radial head and overall specific patterns of traumatic elbow instability [18]. A common fracture mechanism involving the anterolateral part of the radial head occurs in most patients with displaced partial articular fractures [18]. The most common location of displaced articular fractures of part of the radial head (Mason type 2) is the anterolateral quadrant with the forearm in neutral rotation [28].

Complex Injuries: Recognition of the triad of triceps avulsion, radial head fracture, and medial collateral ligament rupture is key to appropriate treatment [25]. A comprehensive classification of complex fracture-dislocations of the elbow was created that appeared to be reproducible [45]. This comprehensive classification of complex fracture-dislocations of the elbow may represent a useful tool for the management of such difficult injuries [45].

Clinical Presentation

Radial head and neck fractures present with distinct epidemiological characteristics, warranting consideration for osteoporosis in a subset of patients [7]. The clinical and radiographic outcomes of these injuries are characteristic to their classification [6]. While MRI may reveal multiple associated injuries, most findings are not symptomatic or of clinical importance in short-term follow-up [12].

Diagnosis and Displacement: Determination of displacement is critical, yet observers demonstrate moderate disagreement regarding the diagnosis of displacement in apparently isolated, stable partial fractures, suggesting displacement is frequently overdiagnosed [15]. In isolated displaced type II partial articular radial head fractures, it is essential to identify which structures require repair to avoid complications leading to elbow instability [9]. Fracture maps indicate no association between fracture line distribution and specific patterns of traumatic elbow instability [18].

Management Outcomes: Conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications [3]. Long-term patient-reported outcomes are excellent following nonoperative management of isolated stable fractures of the radial head or neck [2]. Nonsurgical management of minimally displaced radial neck fractures produces excellent results in most patients [23]. Conversely, open reduction of proximal radius fractures in children is associated with particularly poor outcomes [23]. For isolated partial articular radial head fractures with displacement greater than 2 mm but less than 5 mm, no clinical benefit with ORIF was found compared to nonoperative management at short-term follow-up [4].

Arthroplasty and Resection: At short-term follow-up, arthroplasty with a metal radial head implant is a safe and effective treatment option for unreconstructible radial head fractures [8]. Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement [1]. Radial head fractures treated by early resection arthroplasty offer satisfactory functional results in 96% of patients at long-term follow-up, despite radiographic degenerative changes in the majority of cases [5]. A 69-year clinical and radiologic follow-up of a previously unknown radial head prosthesis has been reported [13], and the outcomes of revision surgery for radial head prostheses are favorable [14]. In terrible triad injuries, the outcome is similar whether the radial head was excised or replaced [16], though treatment of the radial head may have an independent effect on overall outcome [11].

Instability and Red Flags: Forearm instability results from traumatic disruption of the radial head, interosseous membrane, and triangular fibrocartilage complex [22]. Delayed recognition and treatment of forearm instability lead to poor outcomes, making timely diagnosis and appropriate initial intervention imperative [22]. Recognition of the triad of triceps avulsion, radial head fracture, and MCL rupture is the key to appropriate treatment [25]. In terrible triad injuries, while no patient- or injury-related factors were associated with reoperation risk, radial head treatment was associated with an increased risk [19].

Investigations

Plain radiography: While standard imaging is the initial modality, observers demonstrate moderate disagreement regarding the diagnosis of displacement in apparently isolated, stable partial fractures, suggesting that displacement is frequently overdiagnosed [15]. Fracture maps indicate a common mechanism involving the anterolateral part of the radial head, with quantitative analysis confirming the most common location of displaced articular fractures (Mason type 2) is the anterolateral quadrant with the forearm in neutral rotation [18, 28].

MRI: Although MRI identifies numerous injuries in patients with radial head fractures, most of these findings are not symptomatic or of clinical importance in short-term follow-up [12].

CT: Computed tomography, particularly when combined with the coronoid opening angle, serves as a valuable adjunct for evaluating elbow injuries and aids in clinical decision-making [27].

Elbow arthroscopy: Arthroscopy possesses significant diagnostic value compared to standard radiological imaging, revealing concomitant injuries even in patients with uneventful MRI or CT findings [39].

Other Considerations: Distinct epidemiological characteristics exist for radial head and neck fractures, warranting consideration for osteoporosis in a subset of patients [7]. Complications are characteristic to the fracture classification [6], emphasizing the need to assess for concurrent injuries and specific complications related to each treatment modality rather than relying solely on general elbow function outcomes in comminuted fractures [20]. In isolated displaced type II partial articular radial head fractures, it is critical to determine which structures require repair to avoid complications leading to elbow instability [9].

Treatment

Non-Operative

Conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications [3]. Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck [2]. Nonsurgical management of minimally displaced radial neck fractures produces excellent results in most patients [23]. Fracture displacement of 2 to 3 mm is not necessarily an indication for surgical fixation in isolated fractures of the radial head [26]. No clinical benefit with ORIF could be found compared to nonoperative management of isolated partial articular radial head fractures with displacement of greater than 2 mm but less than 5 mm at short-term followup [4]. Intra-articular use of local anaesthetic after joint aspiration does not offer any benefit over aspiration alone in the treatment of undisplaced radial head fractures [51].

Operative

Indications: Arthroplasty with a metal radial head implant was found to be a safe and effective treatment option for patients with an unreconstructible radial head fracture at short-term followup [8]. For displaced fractures with greater than 3 fragments, radial head replacement is recommended [46]. Arthroplasty may be preferred over tenuous fracture fixation in the setting of associated ligament injuries [46]. Treatment of radial head fractures may have an independent effect on outcome; authors recommend reconstruction of comminuted radial head fractures in the context of a terrible triad injury, providing stable fixation can be achieved [11]. Radial head treatment was associated with increased reoperation risk in terrible triad injuries, leading to a recommendation for fixation when feasible [19].

Surgical Approach / Technique: Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement [1]. 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 [10]. 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 [5]. The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient's radial head was excised or replaced [16].

Implant Selection: No significant difference was found between monopolar and bipolar radial head prostheses in terms of efficacy and safety [43]. Patients with radial head arthroplasty (RHA) implanted within 4 weeks for nonreconstructable fractures of the radial head sustained a limited number of failures and obtained a good long-term clinical outcome despite a relatively high rate of post-traumatic arthritis [17].

Revision: The clinical and radiographic outcomes of revision surgery of radial head prostheses are favorable [14].

Other Considerations: It is important to assess for concurrent injuries and specific complications related to each treatment modality rather than solely relying on general elbow function outcomes [20]. Open reduction of proximal radius fractures in children has been associated with particularly poor outcomes [23].

Complications

Instability: Complications of radial head fractures are characteristic to their classification [6]. In isolated displaced type II partial articular radial head fractures, determining which structures require repair is critical to avoid complications that could lead to elbow instability [9]. Osteoporosis should be considered in a subset of patients with radial head and neck fractures as a potential contributing factor [7].

Aseptic loosening: While arthroplasty with a metal radial head implant is a safe and effective treatment option for unreconstructible radial head fractures at short-term follow-up [8], longer-term studies are required to ascertain whether the benefits of radial head arthroplasty are offset by late complications such as loosening [24]. Long-term follow-up data for metal radial head implants in unreconstructible fractures is still needed [8].

Post-traumatic arthritis: Despite a relatively high rate of post-traumatic arthritis, patients with radial head arthroplasty (RHA) obtained good long-term clinical outcomes [17]. Radiographic degenerative changes are present in the great majority of cases following early resection arthroplasty for radial head fractures [5].

Nerve palsy: The incidence of neurologic complications associated with surgical treatment of complex elbow fractures requiring radial head prosthesis implantation may be underestimated in the literature [53].

Other Considerations: Patients with comminuted radial head fractures treated with radial head replacement demonstrate good medium-term outcomes [1]. Nonoperative management of isolated stable fractures of the radial head or neck results in excellent long-term patient-reported outcomes [2]. Conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications [3]. Operative fixation (ORIF) provides no clinical benefit compared to nonoperative management for isolated partial articular radial head fractures with displacement greater than 2 mm but less than 5 mm at short-term follow-up [4]. Early resection arthroplasty for radial head fractures offers satisfactory functional results in 96% of patients at long-term follow-up [5]. Radial head implants offer reliable treatment for complex Mason type III and IV fractures with good functional and survival outcomes and a low incidence of complications [10]. Most injuries found with MRI in patients with radial head fractures are not symptomatic or of clinical importance in short-term follow-up [12]. A McKee radial head prosthesis has been reported with 69-year clinical and radiologic follow-up [13]. Patients with radial head arthroplasty (RHA) implanted within 4 weeks for nonreconstructable fractures sustained a limited number of failures [17].

Recovery

Light activity (weeks): Patients with isolated stable fractures of the radial head or neck managed nonoperatively return to light activities, including desk work and driving, following a course where long-term patient-reported outcomes are excellent [2]. Conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications, supporting early mobilization [3]. For unreconstructible fractures treated with arthroplasty, early resection arthroplasty offers satisfactory functional results in 96% of patients at long-term follow-up, despite radiographic degenerative changes [5].

Full activity (months): Patients with complex Mason type III and IV fractures treated with radial head implants achieve good functional and survival outcomes, allowing a return to full activity [10]. Arthroplasty with a metal radial head implant is a safe and effective treatment option for unreconstructible fractures at short-term followup [8]. In terrible triad injuries, the outcome is similar whether the radial head was excised or replaced, permitting comparable return to function [16]. Most injuries identified via MRI in patients with radial head fractures are not symptomatic or of clinical importance in short-term follow-up, suggesting that full activity can be pursued without addressing incidental findings [12].

Complete recovery / outcome plateau (months): Patients with radial head replacement implants sustained within 4 weeks for nonreconstructable fractures obtain a good long-term clinical outcome, despite a relatively high rate of post-traumatic arthritis [17]. While 2-year Kaplan-Meier survival free of revision or resection estimates and reoperation rates were equivalent between acute and delayed groups, the delayed group experienced worse Mayo Elbow Performance Score outcomes, a higher revision or resection rate at 5 years, and an increased rate of radiographic loosening [54]. Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement [1].

Rehabilitation protocol: No clinical benefit with ORIF could be found compared to nonoperative management of isolated partial articular radial head fractures with displacement of greater than 2 mm but less than 5 mm at short-term followup, supporting nonoperative protocols for this specific displacement range [4]. At short term, there were no differences between patients treated with ORIF for isolated radial head fractures and those treated for radial head fractures in association with other elbow injuries with regard to pain and disability scores [36].

Functional milestones: Functional trajectories are influenced by the timing of intervention; delayed groups experienced worse Mayo Elbow Performance Score outcomes compared to acute groups, even when survival rates were equivalent at 2 years [54].

Other Considerations: Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement [1]. Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck [2]. Conservative management of isolated Mason II radial head fractures yields favorable therapeutic outcomes with a low incidence of complications [3]. 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 [10].

Key Evidence

  • [L5] Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement. (10.1016/j.jhsa.2012.10.001)
  • [L4] Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. (10.2106/jbjs.m.01354)
  • [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. (10.1186/s13018-024-05039-6)
  • [L3] No clinical benefit with ORIF could be found compared to nonoperative management of isolated partial articular radial head fractures with displacement of greater than 2 mm but less than 5 mm at short-term followup. (10.1007/s11999-014-3541-x)
  • [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. (10.1016/j.jse.2010.09.005)
  • [L4] The complications of radial head fractures are characteristic to their classification. (10.1016/j.jse.2018.11.047)
  • [L4] Radial head and neck fractures have distinct epidemiological characteristics, and consideration for osteoporosis in a subset of patients is recommended. (10.1016/j.jhsa.2011.09.034)
  • [L4] At the time of short-term followup, arthroplasty with a metal radial head implant was found to have been a safe and effective treatment option for patients with an unreconstructible radial head fracture; however, long-term follow-up is still needed. (10.2106/00004623-200108000-00010)
  • [L3] It is important to determine which structures need to be repaired to avoid complications that could lead to elbow instability. (10.1016/j.jse.2019.07.006)
  • [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. (10.1016/j.jse.2025.05.038)
  • [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. (10.1302/0301-620x.102b12.bjj-2020-2145)
  • [L2] Most injuries found with MRI in patients with radial head fractures are not symptomatic or of clinical importance in short-term follow-up. (10.1016/j.jse.2011.06.011)
  • [L4] We have reported a 69-year clinical and radiologic follow-up of a previously unknown radial head prosthesis. (10.1016/j.jse.2014.09.030)
  • [L4] The clinical and radiographic outcomes of revision surgery of radial head prostheses are favorable. (10.1016/j.jse.2016.09.047)
  • [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. (10.1016/j.jse.2006.10.015)
  • [L3] The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient's radial head was excised or replaced. (10.1302/0301-620x.100b11.bjj-2018-0293.r1)
  • [L4] However, patients with RHA implanted within 4 weeks for nonreconstructable fractures of the radial head sustained a limited number of failures and, despite a relatively high rate of post-traumatic arthritis, obtained a good long-term clinical outcome. (10.1016/j.jse.2025.06.026)
  • [L4] Fracture maps demonstrated no association between fracture line distribution and location of displaced partial articular fractures of the radial head and overall specific patterns of traumatic elbow instability, suggesting a common fracture mechanism that involves the anterolateral part of the radial head in most patients. (10.1016/j.jse.2016.01.030)
  • [L3] No patient- or injury-related factors were associated with the reoperation risk, but radial head treatment was associated with increased risk, leading to a recommendation for fixation when feasible. (10.1097/corr.0000000000001391)
  • [L4] It emphasizes the importance of assessing for concurrent injuries and specific complications related to each treatment modality rather than solely relying on general elbow function outcomes. (10.1016/j.jse.2011.02.013)
  • [L5] Radial head arthroplasty is a reliable procedure for complex radial head fractures not amenable to reconstruction, particularly when associated with unstable elbows or forearm injuries, provided concomitant injuries are addressed. (10.1016/j.jhsa.2009.01.027)
  • [L5] Forearm instability results from traumatic disruption of the radial head, interosseous membrane, and triangular fibrocartilage complex; delayed recognition and treatment lead to poor outcomes, making timely diagnosis and appropriate initial intervention imperative. (10.1016/j.jhsa.2013.07.010)
  • [L5] Nonsurgical management of minimally displaced radial neck fractures produces excellent results in most patients, whereas open reduction has been associated with particularly poor outcomes. (10.5435/jaaos-d-18-00204)
  • [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. (10.1007/s11999-013-3331-x)
  • [L4] Recognition of the triad of triceps avulsion, radial head fracture, and MCL rupture is the key to appropriate treatment. (10.1016/j.jse.2011.06.017)
  • [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. (10.1016/j.jse.2013.01.019)
  • [L4] It can be of value alongside 3-dimensional imaging in evaluating elbow injuries and used as an adjunct in clinical decision making. (10.1016/j.jse.2021.12.039)
  • [L4] This quantitative analysis confirms that the most common location of displaced articular fractures of part of the radial head (Mason type 2) is the anterolateral quadrant with the forearm in neutral rotation. (10.1016/j.jse.2011.08.056)
  • [L5] Despite the complexities of this injury, an understanding of the relevant anatomy and the factors associated with elbow stability allows the application of a systematic algorithm for treatment that can help ensure sufficient elbow stability to allow early motion, thereby leading to improved outcomes in most patients. (10.5435/00124635-200903000-00003)
  • [L5] The study successfully created and validated an anatomic model of terrible triad of the elbow by exerting axial compression on an elbow in 15° flexion and maximal pronation at speeds of 100 and 10 mm/min. (10.1186/s13018-024-05069-0)
  • [L4] Early mobilization of the elbow is important for the restoration of elbow range of motion and function. (10.2106/jbjs.d.02710)
  • [L4] Detailed knowledge of fracture characteristics and their association with specific patterns of traumatic elbow instability may assist decision making and preoperative planning. (10.1016/j.jhsa.2014.07.059)
  • [L5] Disruptions in any of these structures may lead to forearm instability with consequences at the remaining structures. (10.1016/j.jhsa.2016.10.017)
  • [L5] Understanding the patterns of traumatic elbow instability helps the surgeon counsel and manage patients with these injuries. (10.1016/j.jhsa.2010.05.002)
  • [L3] At short term, there were no differences between patients treated with ORIF for isolated radial head fractures and those treated for radial head fractures in association with other elbow injuries with regard to pain and disability scores. (10.1007/s11999-014-3519-8)
  • [L5] Elbow arthroscopy has become a safer and more effective treatment modality for several elbow pathologies due to advances in equipment and surgical technique. (10.5435/00124635-200810000-00003)
  • [L4] Although the nature of floating elbow injuries is complex, the presence of nerve injury and intra-articular involvement predispose to worse clinical outcomes. (10.1016/j.jse.2012.09.005)
  • [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. (10.1186/s12891-019-2726-6)
  • [L4] This study adds to the evidence that the terrible triad of the elbow is surgically treatable to allow a high functional standard not only in the short-term but also in the long term. (10.1016/j.jse.2024.06.023)
  • [L3] Using a standardized protocol, sufficient elbow stability and good outcomes can be achieved in most terrible triad injuries. (10.1302/0301-620x.102b12.bjj-2020-0762.r1)
  • [L5] Long-term outcome with surgical management of complex elbow injuries is unknown. (10.5435/00124635-200605000-00003)
  • [L1] No significant difference was found between monopolar and bipolar radial head prostheses in terms of efficacy and safety. (10.1016/j.jse.2021.10.037)
  • [L4] Despite the presence of greater flexion contractures at the time of follow-up in elbows with Type-IV fractures or fractures with an ipsilateral radial head fracture, good to excellent outcomes with functional ulnohumeral motion can be achieved following internal fixation of these complex fractures. (10.2106/jbjs.g.00940)
  • [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. (10.1016/j.jse.2011.06.003)
  • [L5] For displaced fractures with greater than 3 fragments, radial head replacement is recommended, and arthroplasty may be preferred over tenuous fracture fixation in the setting of associated ligament injuries. (10.1016/j.jhsa.2008.12.024)
  • [L4] In selected terrible triad cases, when the elbow is well aligned and the radial head and coronoid fractures are relatively small and minimally displaced after closed reduction with no mechanical block to motion, patients might regain good elbow function without surgery. (10.1016/j.jhsa.2009.12.015)
  • [L4] Trans-olecranon fracture posterior dislocation is a rare injury with unique characteristics involving complex elbow instability. (10.1186/s13018-023-03563-5)
  • [L4] Postoperative complications including synostosis and elbow instability may not be as common as previously understood. (10.1016/j.jse.2023.06.005)
  • [L1] Intra-articular use of local anaesthetic after joint aspiration does not offer any benefit over aspiration alone in the treatment of undisplaced radial head fractures and its routine application is not supported by the clinical data. (10.1016/j.jse.2009.04.003)
  • [L4] The incidence of neurologic complications associated with the surgical treatment of complex elbow fractures requiring implantation of a radial head prosthesis may be underestimated in the literature. (10.1016/j.jse.2020.01.086)
  • [L3] Although 2-year Kaplan-Meier survival free of revision or resection estimates and reoperation rates were equivalent between the groups, the delayed group experienced worse Mayo Elbow Performance Score outcomes, a higher revision or resection rate at 5 years, and an increased rate of radiographic loosening. (10.1016/j.jse.2022.07.031)

See Also

References

[1] Radial Head Fractures. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.10.001

[2] Long-Term Outcomes of Isolated Stable Radial Head Fractures. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.01354

[3] Comparison of operatively and nonoperatively treated isolated mason type II radial head fractures: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05039-6

[4] Is ORIF Superior to Nonoperative Treatment in Isolated Displaced Partial Articular Fractures of the Radial Head?. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-014-3541-x

[5] Resection arthroplasty for radial head fractures: Long-term follow-up. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.09.005

[6] Surgical revision of radial head fractures: a multicenter retrospective analysis of 466 cases. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.11.047

[7] The Epidemiology of Radial Head and Neck Fractures. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.09.034

[8] Arthroplasty with a Metal Radial Head for Unreconstructible Fractures of the Radial Head. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200108000-00010

[9] Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.07.006

[10] Long-term survival of Acumed anatomical radial head implant for Mason type III-IV fractures: a 15-year follow-up. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.05.038

[11] Infographic: Surgical treatment of the radial head in terrible triad injuries of the elbow. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b12.bjj-2020-2145

[12] Magnetic resonance imaging in radial head fractures: most associated injuries are not clinically relevant. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.06.011

[13] Sixty-nine-year follow-up of a McKee radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.09.030

[14] Clinical and radiographic outcome of revision surgery of radial head prostheses: midterm results in 16 patients. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.09.047

[15] Apparently isolated partial articular fractures of the radial head: Prevalence and reliability of radiographically diagnosed displacement. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.10.015

[16] Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b11.bjj-2018-0293.r1

[17] What happens to the elbow 15 years after a radial head prosthesis? A clinical and imaging long-term follow-up study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.06.026

[18] Fracture mapping of displaced partial articular fractures of the radial head. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.01.030

[19] What Factors Are Associated with Reoperation After Operative Treatment of Terrible Triad Injuries?. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001391

[20] Comminuted radial head fractures: aspects of current management. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.02.013

[21] Radial Head Implant Arthroplasty. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.01.027

[22] Forearm Instability. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.07.010

[23] Proximal Radius Fractures in Children. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00204

[24] Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-3331-x

[25] Triceps avulsion, radial head fracture, and medial collateral ligament rupture about the elbow: a report of 4 cases. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.06.017

[26] A retrospective cohort study of displaced segmental radial head fractures: is 2 mm of articular displacement an indication for surgery?. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.019

[27] The coronoid opening angle: a novel radiographic technique to assess bone loss in coronoid trauma. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.12.039

[28] Quantitative measurement of radial head fracture location. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.08.056

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