Radial Head Replacement

Indications

Posterolateral Approach to Radial Head, radiograph of a radial head fracture
Radiograph of a radial head fracture. Image by James Heilman, MD, Wikimedia Commons, CC BY-SA 4.0.
  • Comminuted radial head fractures that cannot be reconstructed, more than three fragments
  • Fractures with elbow instability, terrible triad and Essex-Lopresti injuries
  • Mason type III fractures where fixation would be unstable
  • Radial head excision alone is avoided when the elbow or forearm is unstable

Position

  • Supine with arm table, or lateral
  • Image intensifier available
  • Tourniquet

Operative Steps

  1. Kocher interval between ECU and anconeus, or Kaplan interval between EDC and ECRB
  2. Keep the forearm pronated to move the posterior interosseous nerve away
  3. Protect the lateral ulnar collateral ligament
  4. Excise fragments and reassemble them to size the implant, choosing smaller if between sizes
  5. Neck cut perpendicular to the shaft
  6. Trial and avoid overstuffing. Lateral ulnohumeral joint space should match the medial
  7. Repair the lateral ligament complex to the epicondyle
  8. Radiographs and fluoroscopy check the ulnohumeral joint for gapping
  9. Monopolar or bipolar implants with smooth or porous stems
  10. Repair the coronoid and medial structures when part of a terrible triad

Postoperative Care

  • Early protected motion
  • Splint for instability patterns
  • Hinged brace for instability patterns
  • Rehabilitation over 3 months

Complications

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.