Displaced, unstable fractures of the radial head: fixation vs. replacement--what is the evidence?

Unstable, displaced fractures of the radial head nearly always occur in association with other fractures or ligament injuries. Radiocapitellar contact is important to elbow and forearm stability and should be restored in the context of such injuries. Open reduction and internal fixation of the radial head is associated with early failure, nonunion, and poor forearm motion. Replacement of the radial head with a metal prosthesis may be preferable. The major pitfall of a metal prosthesis is insertion of a prosthesis that is too large in longitudinal length, which can lead to subluxation, capitellar wear, stiffness, and pain. When this is avoided the medium- and long-term results are satisfactory with no major problems identified.