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

Abstract

Radial head (RH) arthroplasty (RHA) has emerged as a critical intervention in the management of complex elbow fractures, particularly Mason type III and IV injuries where the native RH is irreparable. Beyond its role in pain relief and joint congruity, RHA serves as a biomechanical cornerstone for restoring the lateral column and ensuring elbow stability, especially in the presence of associated ligamentous injuries or fracture-dislocations. This editorial synthesizes current evidence on RHA in Mason type III and IV RH fractures, with attention to biomechanical rationale, implant design, and complication trends. Aiming to reaffirm RHA’s position as a vital tool in contemporary elbow trauma care, a simplified treatment algorithm is presented to support individualized surgical decision-making.

Keywords: Radial head arthroplasty; Mason classification; Comminuted radial head fractures; Modular prosthesis; Aseptic loosening; Overstuffing; Cost-effectiveness

Core Tip: Radial head (RH) arthroplasty has become a preferred treatment option for non-reconstructable Mason type III and IV RH fractures, particularly when associated with elbow instability. This editorial examines the anatomical and biomechanical rationale for RH arthroplasty, evaluates prosthetic design evolution, and critically reviews clinical outcomes and complication patterns. Special emphasis is placed on common failure modes such as aseptic loosening, overstuffing, and stiffness, as well as its cost-effectiveness in comparison to alternative surgical strategies. The aim is to provide a comprehensive, evidence-based perspective to guide surgical decision-making in complex elbow trauma. A treatment algorithm is provided to aid surgical decision-making in Mason type III and IV RH fractures, based on fracture morphology and elbow stability.