Radial-head replacement

Not every radial-head fracture is treated the same way. Many are stable and minimally displaced and are treated without surgery. When a fracture does need surgery, the first choice is often to fix it — to reconstruct the radial head with hardware — when the fragments allow a reliable repair.

Radial-head replacement is considered when the fracture is too fragmented to reconstruct dependably and the radial head is important to the stability of the elbow or forearm. Replacement is not automatically preferable to fixation in every comminuted fracture; it is one option, chosen for fractures that cannot be reliably rebuilt.

The radial head sits at the outer side of the elbow, where it helps the elbow resist being pushed sideways and helps keep the forearm stable as it rotates. Because of this stabilizing role, simply removing a badly broken radial head can, in some injuries, leave the elbow or forearm less stable.

Replacing the radial head restores a support at that outer corner of the elbow, which is why replacement is often chosen — rather than removal — when the native radial head cannot be reconstructed and its stabilizing role is needed.

A badly broken radial head often occurs as part of a more complex injury — for example a terrible-triad fracture-dislocation, where the elbow has dislocated and the coronoid and ligaments are also injured. In those situations, replacing the radial head is one part of a larger operation that also addresses the other injured structures to restore overall stability.

So while this page focuses on the replacement itself, it is frequently one component of managing a complex elbow injury rather than an isolated procedure. The complex elbow fracture-dislocation surgery page describes how the parts fit together.

In a radial-head replacement, the surgeon removes the fragments of the broken radial head and places an implant that restores its shape and its role as a stabilizer at the outer elbow. The implant is sized to the individual anatomy, and any injured ligaments or other fractures are addressed as part of the operation when the replacement is one component of a complex injury.

This page does not name specific implants or make mechanical claims about them. The particular implant and technique are chosen by your surgeon based on the injury and the anatomy.

When a radial-head replacement is performed on its own for an isolated fracture where the rest of the elbow is stable, recovery follows the plan for that operation. When the replacement is one component of a more complex reconstruction — such as a terrible triad — the rehabilitation is guided by the whole injury and by the plan your surgeon selects for it, which is often more protective.

In practical terms: if your surgeon has selected the terrible-triad rehabilitation plan for a combined reconstruction, that plan governs; a stand-alone radial-head replacement plan applies when it is specifically selected for that operation. In every case, your operative note and the protocol your surgical team chose take precedence over any general document.

Recovery after a radial-head replacement is gradual and staged. Early on, the elbow is protected as your surgeon directs, and protected motion is generally introduced relatively early to limit stiffness. Strength is rebuilt gradually as healing allows, and activity is advanced in stages.

How protective the early phase is depends heavily on whether the replacement was isolated or part of a larger reconstruction, and on the ligaments and other structures involved. The rehabilitation protocols linked below describe the general shape; which one applies, and the specific restrictions, are set by your surgeon, and your operative note takes precedence.

Every operation has trade-offs. The possibilities below are for discussion with your surgeon and are not a complete list:

• Stiffness or loss of some motion
• Residual or recurrent instability of the elbow, particularly within a complex injury
• A problem with the implant — loosening, wear, an implant that is not ideally sized, or the need to remove or revise it later
• Nerve symptoms or, less commonly, a nerve injury
• Extra bone forming around the elbow (heterotopic ossification)
• Infection
• Later elbow arthritis
• A need for further treatment or surgery

The goal of a radial-head replacement is to restore a stabilizer at the outer elbow so the joint — often as part of a larger repair — is stable and able to move. Recovery is gradual and protected, some stiffness is common, and results are individual; no particular motion, strength, timeline, or implant lifespan can be guaranteed. Whether replacement is the right choice, and how it fits your overall injury, is decided with your surgeon.