Overview
The radial head is the disk-shaped top of the radius (the forearm bone on the thumb side). It sits in the elbow joint and spins as you turn your palm up and down. It also helps hold the elbow steady. Many simple radial-head fractures heal well with early motion in a sling.
Surgery is considered in three settings: fractures pushed out of place that block motion, fractures that come with an unstable elbow (such as terrible-triad injuries), and heads broken into too many pieces to put back together. In the last case, the head is replaced with a metal implant rather than repaired.
Why it's done
Radial head fixation or replacement is usually considered when the fracture will not reliably heal or work well on its own. Imaging and the exam together guide that call. Common reasons include:
Displaced fracture blocking forearm rotation
A broken piece that catches in the joint must be fixed.
Associated elbow instability
Terrible-triad and other combined injuries require reconstruction.
Fracture with more than three fragments
Putting the pieces back together is usually unreliable, so replacement is preferred.
Open fracture
Urgent surgical cleaning and stabilization.
How it works
For fractures that can be put back together, small screws or a small plate hold the pieces. The surgeon works through a small incision on the outer side of the elbow. Hardware sits on the part of the radial head that does not rub against other bones when you rotate your forearm.
When the head is too shattered to repair, a metal implant sized to match your original head is set into the radial neck. The implant restores elbow stability and lets you start moving the joint right away.
Recovery
Starting to move the elbow early is critical after radial head surgery. A short splint is used for comfort at first, then motion begins quickly. Strengthening is added once healing is confirmed. Full recovery is gradual. Your surgeon will check progress at each follow-up visit. Stiffness, heterotopic ossification (extra bone that can form around the joint after injury), and implant-related symptoms are known concerns. Hardware removal is rarely needed.
Contact
For questions about this procedure or to set up a visit, call the office at (830) 625-0009 or schedule an appointment online.
Physicians Who Perform Radial Head Fixation or Replacement
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once hardware holds the fracture steady, gentle weight through the limb helps the bone heal. Keeping all weight off 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 hardware before bone has caught up.
The right answer sits in between. Your surgeon sets a step-by-step weight-bearing plan. It rests on your fracture pattern, how strong the fixation is, your bone quality, and how the repair looks on imaging after surgery. 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. This procedure is offered because the condition, when left untreated, can cause an elbow that is painful, unstable on its outer side, and unable to reliably rotate the forearm, since the radial head is an important stabilizer. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
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 arthritis between the radial head and the outer part of the elbow joint (radiocapitellar arthritis)
- posterior interosseous nerve irritation from the lateral exposure
The indication to proceed is a displaced or shattered radial head fracture that blocks forearm rotation or contributes to elbow instability. If you do not need this operation, we will not recommend it.
Frequently Asked
questions we hear in clinicDo all radial head fractures need surgery?
No. Many simple radial-head fractures heal well with early motion in a sling. Surgery is considered for fractures pushed out of place that block motion, fractures that come with an unstable elbow, and heads broken into too many pieces to put back together.
When is the radial head replaced instead of repaired?
When the head is broken into more than three fragments, putting the pieces back together is usually unreliable. In that case a metal implant sized to match your original head is set into the radial neck, which restores elbow stability and lets you start moving the joint right away.
How soon can I move my elbow?
Starting to move the elbow early is critical after radial head surgery. A short splint is used for comfort at first, then motion begins quickly, and strengthening is added once healing is confirmed.
Will the hardware need to come out later?
Hardware removal is rarely needed. The screws or plate sit on the part of the radial head that does not rub against other bones when you rotate your forearm, though hardware irritation requiring later removal is one of the risks we discuss.
How much weight can I put through the arm?
Your surgeon sets a step-by-step weight-bearing plan based on your fracture pattern, how strong the fixation is, your bone quality, and how the repair looks on imaging after surgery. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
What are the main risks?
The risks we discuss include stiffness, heterotopic ossification (extra bone that can form around the joint after injury), hardware irritation, non-union of small fragments, arthritis between the radial head and the outer part of the elbow joint, and nerve irritation from the exposure.
Further Reading
External patient-education references and related OSI pages for additional background: