Overview
The radial head is the disk-shaped top of the radius that sits in the elbow joint and rotates during forearm supination and pronation. It is also a key stabilizer of the elbow. Many simple radial-head fractures heal well with early motion in a sling.
Surgery is considered for displaced fractures that block motion, for fractures associated with elbow instability (such as terrible-triad injuries), and for severely comminuted heads that cannot be reconstructed. In the last case, the head is replaced with a metal prosthesis rather than repaired.
Why it's done
Radial head fixation or replacement is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Displaced fracture blocking forearm rotation
A fragment that catches in the joint must be addressed.
Associated elbow instability
Terrible-triad or Essex-Lopresti injuries require reconstruction.
Fracture with more than three fragments
Reconstruction is typically unreliable; replacement is preferred.
Open fracture
Urgent debridement and stabilization.
How it works
For reparable fractures, headless compression screws or a small plate hold the fragments after a limited lateral approach. Implants are placed in the safe (non-articulating) zone of the radial head.
For unreconstructable heads, a modular metal radial head prosthesis is sized to match the patient's native head and inserted into the radial neck. The prosthesis restores elbow stability and allows immediate motion.
Recovery
Early range-of-motion is critical for all radial head surgery. A brief splint is used for comfort, then motion begins early. Strengthening is added once the repair is well on its way. Full recovery is gradual, with milestones your surgeon will discuss at follow-up. Stiffness, heterotopic ossification, and implant-related symptoms (in replacements) are known concerns. Hardware removal is rarely needed for fixation constructs.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a laterally unstable, painful elbow that cannot reliably rotate the forearm — the radial head is a secondary but important stabilizer. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before radial head fixation or replacement include:
- bleeding and infection
- anesthesia risk
- stiffness
- heterotopic ossification
- hardware irritation requiring later removal
- non-union of small fragments
- progression to radiocapitellar arthritis
- posterior interosseous nerve irritation from the lateral exposure
The indication to proceed is a displaced or comminuted radial head fracture that blocks rotation or contributes to elbow instability. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: