Radial head arthroplasty: A pillar of stability in complex elbow fractures

Table 1 Indications, advantages and disadvantages of surgical management options of radial head fractures

Surgical option	ORIF	RHA	RHR
Indications	Type II RHFs with mechanical block; and reconstructible type III and IV RHFs with simple fracture patterns	Unreconstructible RHFs, especially comminuted patterns; unreconstructible RHFs associated with ligamentous injury or elbow dislocation; instability following RHR; and failure of ORIF	Low-demand patients with stable elbows; salvage procedure following failed fixation or failed arthroplasty, in patients with stable elbow and low functional demand
Advantages	Restores native anatomy; and good for simple patterns	Good functional outcomes; maintains elbow stability; prevents proximal radial migration; and reduces early arthritis	Tolerated in low-demand patients despite mild instability
Limitations	Difficult in comminuted fractures; poorer outcomes in complex cases; and risk of nonunion and hardware failure	Complications are not rare; requires precise technique; small studies limit evidence; long-term data limited for young patients; and delayed RHA yields poorer outcomes	Alters elbow biomechanics; loss of RH’s stabilizing role, loss of support against valgus and axial forces; loss of PRUJ or DRUJ stability and proximal radial migration; and increases load on humero-ulnar joint, accelerate degenerative changes
Complication profiles	Nonunion; hardware failure; limited pronation/supination; and may require conversion to RHA	Painful loosening, radiolucency, overstuffing, osteoarthritis, HO, erosion, stiffness; PIN injury, dislocation, infection; reoperation rate: 12%-26%; and revision rate: 0%-45%	Early elbow instability; delayed: Cubitus valgus, proximal radial migration, arthritis, grip weakness, ulnar nerve irritation secondary to valgus overload or instability; and chronic elbow instability

ORIF: Open reduction and internal fixation; RHF: Radial head fracture; RHA: Radial head arthroplasty; RHR: Radial head resection; HO: Heterotopic ossification; PIN: Posterior interosseous nerve; PRUJ: Proximal radioulnar joint; DRUJ: Distal radioulnar joint.