Fractures of the radial head are the most common skeletal injury in the adult elbow. The majority occur in middle-aged individuals between 20 and 60 years of age. The most common mechanism of injury involves a fall on the outstretched hand with the forearm pronated and the elbow partially flexed.

Repair of radial head fractures with small screws or plates is technically demanding due to the small and often comminuted nature of the fragments. When radial head fractures are too comminuted to allow for stable internal fixation, a decision must be made whether to excise or replace the head. With intact ligaments, resection will not result in motion loss but will lead to weakness in grip and forearm loading. In fractures with associated elbow joint dislocation or forearm interosseous ligament failure, resection is contraindicated.

In this setting, implants are required to restore the valgus and axial load bearing functions of the radial head and allow proper healing of the soft-tissues. Silicone prostheses are no longer recommended as replacements for the radial head following trauma. They lack the necessary biomechanical support for the elbow joint. Newer metallic radial head implants are now available in monopolar and bipolar designs. The bipolar implants have the theoretical advantage of more uniform stress transfer to the capitellum.

Outcomes with these new metallic implants are typically very successful, but careful sizing and surgical technique are critical.

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