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Trauma & Fractures

Radial Head Fracture

The Most Common Adult Elbow Fracture

Expert treatment from conservative care to ORIF and radial head replacement

Understanding Radial Head Fractures

Radial head fractures are the most common elbow fracture in adults, accounting for approximately 33% of all elbow fractures. They typically result from a fall onto an outstretched hand (FOOSH).

Key Facts

  • • Most common elbow fracture in adults
  • • Peak age: 30-40 years
  • • Equal gender distribution
  • • Often associated with other injuries (30%)
  • • Important for elbow stability and forearm rotation

Check for Associated Injuries

Always assess for: elbow ligament injuries (MCL, LCL), coronoid fracture, capitellum fracture, and Essex-Lopresti injury (disruption of interosseous membrane with DRUJ instability).

Mason Classification

Type I
Non-displaced / <2mm

Marginal fracture without mechanical block

Treatment: Sling, early motion

Excellent prognosis - 90%+ good outcomes

Type II
Displaced >2mm, partial head

Fragment involves >30% of articular surface or mechanical block

Treatment: ORIF (screws/plate)

Good results with anatomic fixation

Type III
Comminuted, entire head

Severely fragmented, not reconstructable

Treatment: ORIF if possible, or replacement

Radial head replacement if unstable elbow

Type IV
Any fracture + dislocation

Mason-Johnston modification - associated elbow dislocation

Treatment: Address stability first

Often requires surgery

Treatment Options

Non-Operative (Type I)
  • • Aspiration of hemarthrosis (reduces pain, allows assessment)
  • • Sling for comfort (3-7 days)
  • • Early active ROM within 1-2 weeks
  • • Avoid resisted pronation/supination initially

Outcome: 90%+ excellent results

ORIF - Open Reduction Internal Fixation

Indicated for Type II with mechanical block and repairable Type III

Fixation Options

  • • Headless compression screws
  • • Mini-fragment screws (2.0-2.4mm)
  • • Low-profile plates

Safe Zone

Hardware must be placed in non-articulating safe zone (posterolateral 90° arc) to avoid impingement during rotation

Radial Head Replacement

Indicated for unrepairable Type III when stability requires radial head

  • • Metal (cobalt-chrome) monopolar prosthesis
  • • Proper sizing critical (overlengthening causes capitellar wear)
  • • Maintains valgus stability and longitudinal stability

Contraindicated: Isolated stable fractures without ligament injury (can excise instead)

Radial Head Excision

Only for isolated, stable fractures where ORIF not possible

  • • Elbow must be stable (intact MCL, LUCL)
  • • No Essex-Lopresti injury
  • • Reasonable option in low-demand patients

Warning: Excision in unstable elbow leads to progressive valgus instability

Evidence & References

• Mason ML. Some observations on fractures of the head of the radius with a review of 100 cases. Br J Surg 1954

• Johnston GW. A follow-up of 100 cases of fracture of the head of the radius with a review of the literature. Ulster Med J 1962

• Morrey BF. Current concepts in the treatment of fractures of the radial head. JBJS Am 1995

• Ring D. Radial head fracture: open reduction-internal fixation or prosthetic replacement. J Shoulder Elbow Surg 2011

Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)

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