Question
A 51 year old man had surgery for a comminuted radial head fracture with an elbow dislocation.
- What has been done and when is it indicated?
- How do you size the implant and avoid overstuffing?
- What are the complications?
Answer
Procedure
- Radial head arthroplasty (modular metal stem)
- Indicated for comminuted Mason III fractures with over three fragments
- Part of terrible triad and Essex-Lopresti management where the head restores stability
- Radial head is a secondary valgus stabiliser and resists posterolateral and axial instability
Sizing
- Reassemble the fragments to size the head diameter, choose smaller if between sizes
- Top of the implant level with the proximal radioulnar joint at the lesser sigmoid notch
- Medial ulnohumeral joint should be parallel on fluoroscopy
- Lateral ulnohumeral gapping over 1 mm suggests overstuffing
- Overstuffing causes capitellar wear, pain and stiffness
Complications
- Overstuffing and capitellar erosion
- Stem loosening (lucency around smooth press fit stems is common and often painless)
- Stiffness and heterotopic ossification
- PIN injury, pronate the forearm during the approach
- Persistent instability if ligaments are not repaired
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.