Displaced Fractures of the Radial Head: Internal Fixation or Excision?

Displaced fractures of the radial head in the young active patient should no longer be routinely treated with excision of the radial head. Better techniques of imaging, surgical exposure, and implant placement have improved the likelihood of preserving the head. Associated injuries may make preservation of the radial head important for both acute and long-term stability. In patients with suspected injury to the interosseous ligament of the forearm, saving the radial head may prevent pathologic proximal migration. Rigid internal fixation, permitting early mobilization, can be applied to the radial head and neck in a "safe zone" that does not impede motion. Radial-head excision should be performed in patients with grossly comminuted fractures and in those with low demand on their upper extremities.