Radial head fractures

The radial head is the most commonly fractured bone of the elbow, with most fractures occurring in women older than 50 years. The radial head is an important stabilizer for valgus, axial, and posterolateral rotational forces. Loss of articular segments of the radial head negatively affects elbow kinematics and stability. Most fractures are treated nonsurgically. Indications for nonsurgical treatment include nondisplaced and isolated displaced fractures without a block to motion. Fragment excision is indicated when a mechanical block from a small, displaced fragment impedes elbow motion. If technically possible, open reduction and internal fixation is preferred for larger fragments, whereas radial head arthroplasty is reserved for comminuted fractures if reconstruction of the fragments is not possible. Radial head excision can be considered for isolated, displaced, and comminuted fractures in patients with low functional demands; in the presence of infection; or after other treatment modalities have failed. Complications include stiffness, heterotopic ossification, infection, and instability. The indications for surgical versus nonsurgical management of radial head fractures remain controversial.