Radial Head & Neck Fractures

Radial Head Fracture





- axial load with a valgus force




1.  Provides Valgus stability

- especially if MCL deficient


2.  Longitudinal stability

- aided by interosseous membrane


3.  Load Transfer

- 60% of load at elbow

- with radial head excision, load is transferred to ulno-humeral joint

- increase risk of OA


Hotchkiss modification of Mason Classification


Type I


Undisplaced fracture

- intra-articular displacement < 2mm

- no mechanical limit forearm rotation

- if in doubt, inject LA into radiocapitellar joint / soft spot

- ensure no mechanical block to rotation


Radial Head Mason 1Radial Head Fracture Mason 1


Type II


Displacement > 2mm

- motion mechanically limited

- reconstructable


Radial Head Fracture Type 2Radial Head Fracture Type 2 CTRadial Head Fracture Mason 2


Type III


Severely comminuted fracture of the radial head and neck

- not reconstructable

- requires excision for movement


Type IV


Associated with elbow dislocation


Complicated Radial Head Fracture


1.  Elbow Dislocation


2.  Essex Lopresti


Fracture Radial Head + Disruption DRUJ / Interosseous membrane

- dorsal dislocation of DRUJ

- ORIF / replacement radial head

- supinate DRUJ to reduce +/- TFCC repair +/- K wire


Surgical Options


1.  ORIF


Radial Head ORIF


Kocher approach

- between anconeus and ECU

- dissect muscles off capsule

- protect ulna collateral ligament under anterior edge of anconeus

- pronate forearm to protect PIN

- divide capsule in line with incision, create anterior and posterior flaps


Safe Zone for implants

- posterolateral portion of cartilage

- yellow and thinner

- non articulating

- 90o arc between radial styloid and lister's



- headless compression screws





- soft tissue stripping


Non union 

- same reasons

- 10%




Ring et al JBJS Am 2002

- results of ORIF Type III radial head

- overall 54% poor results

- good results with 2 or 3 fragments

- poor results with 4 results


2.  Excision



- elderly patient



- MCL or interosseous membrane disrupted



- reduced strength

- proximal radial translation

- DRUJ instability and pain

- valgus instability elbow

- arthrosis (deceased SA, increased contact stresses)


3.  Replacement


Radial Head Replacement LateralRadial Head Replacement APRadial Head Replacement Monoblock




1.  Silastic 

- less resistant to compressive forces

- can get synovitis

- good as temporary spacer

- can cut out later


2.  Titanium

- monoblock / modular / bipolar


Technique Modular Titanium Radial Head


Radial Head Replacement


Excise radial head

- insert trial broaches into neck

- small or large diameter, standard or long

- insert trial head size and thickness

- check xray

- ensure not overstuffed

- put through range

- prepare real implant on operating table

- have to insert head and neck as one piece


Radial Head Replacement Lysis APRadial Head Replacement Lysis Lateral




Grewal JBJS Am 2006

- modular radial head

- 26 patients followed prosectively for 2 years

- no revisions

- mild OA in 19%


Burhart et al J Should Elbow Surg 2010

- bipolar radial head

- 17 patients followed up for between 6 and 10 years

- 2 dislocations, 8 had evidence capitellar OA

- no loosening

- 16/17 good or excellent results Mayo elbow scores




1.  Aseptic loosening

2.  Overstuffing

3.  Capitellar OA

4.  Malpositioning


Radial Head Poorly Positioned


Radial neck fracture


Radial Neck Fracture


Indications for surgery

- > 30o angulated



- Z incision annular ligament

- elevate supinator with arm pronated




1. T plate in safe zone

- distal limit is bicipital tuberosity

- pre-contoured low profile plates

- may need to lag articular surface first

- check ROM intra-operatively

- plates often bulky and may limit ROM


Radial Neck Plate


2.  Fix with headless compression screws

- proximal to distal

- cross fracture site


Radial Neck Fracture ORIF Screws APRadial Neck Fracture ORIF Screws Lateral


3.  Retrograde Intramedullary Wire


4.  Radial Head Replacement