Early Callus as an Adverse Prognostic Sign Following Radial Head Replacement for Trauma

Radial head fractures are common elbow injuries. Radial head replacement (RHR) is a well-established surgical option for non-reconstructible fractures, either in isolation or alongside associated elbow trauma, such as a terrible triad injury, which is a complex injury characterized by elbow dislocation and coronoid and radial head fractures. The procedure aims to restore the stabilizing function of the radial head, which plays a key role in maintaining longitudinal and valgus stability and an auxiliary role in the varus stability of the elbow. Radial head arthroplasty has gained popularity in recent years, especially with the introduction of anatomically designed prostheses, though it is not without complications. We present a case series of four patients with an early post-operative radiographic sign of callus arising from the lateral aspect of the radial neck at the resection level. This sign should alert treating clinicians that there may be undetected fracture line propagation to the radial neck and a high risk of early prosthetic loosening. Based on our series, consideration of the causes behind the aseptic loosening of press-fit radial head replacement (RHR) implants should include undetected fracture lines of the radial neck.