Fractures of the elbow's lateral column radial head and capitellum

Fractures of the lateral column of the elbow involve radial head fractures or capitellum fractures. As the biomechanics of the elbow have become better understood, the importance of the radiocapitellar joint in stabilizing the elbow has been emphasized. Preservation of the radial head has gained importance. For nondisplaced radial head fractures, good results are generally obtained with a short period of immobilization followed by early range of motion. In managing displaced radial head fractures, improved techniques and more versatile instrumentation have helped make preservation more feasible. Excellent results can be achieved with ORIF. In cases in which ORIF is impossible, prosthetic replacement of the radial head is a sound alternative. Successful results have been obtained with arthroplasty, and with second-generation modular systems, the facility of performing this procedure should increase. Treatment of capitellar fractures has also benefited from improved fixation systems. If the fragment is large enough, reduction and fixation with small screws or Kirschner wires have had good success. Excision works well in patients with fragments that are too small or not amenable to fixation, especially if the other structures of the medial elbow and forearm axis are competent.