Przejdź do treściMost isolated, nondisplaced or only mildly displaced radial head fractures can be treated without surgery. Management usually involves brief support for comfort followed by controlled restoration of motion as early as the injury safely allows. Fragment displacement of more than 2 mm is not, by itself, an automatic indication for an operation. Mechanical blockage of forearm rotation, comminution, elbow instability and associated injuries are more important.
Polish version: Złamanie głowy kości promieniowej — kiedy potrzebna jest operacja?
How does a radial head fracture occur?
The usual mechanism is a fall onto an outstretched hand. Force travels through the wrist and radius to the elbow, where the radial head impacts the distal humerus. The injury may be a small fracture line, a displaced fragment, or — in more severe trauma — a comminuted radial head fracture.
The radial head is not simply a piece of bone that needs to unite. It contributes to elbow stability. In complex injuries, treatment therefore depends not only on the fracture itself but also on the ligaments, the other bony structures around the elbow and the stability of the joint as a whole.
Typical symptoms
- pain on the lateral side of the elbow, particularly after a fall onto the hand,
- swelling and tenderness over the radial head,
- pain or restriction when turning the palm up or down,
- difficulty fully bending or straightening the elbow,
- pain with tasks such as turning a key, a door handle or opening a bottle.
Similar post-traumatic pain can also come from ligaments, cartilage or other elbow structures, so the diagnosis should not be based on pain location alone.
How is the fracture diagnosed?
Assessment should include the whole upper limb rather than only the most painful point. Elbow motion — especially pronation and supination — joint stability, circulation and sensation are checked. The forearm and wrist also deserve examination because some radial head fractures are accompanied by injuries farther from the elbow.
Plain radiographs are the basic imaging test. CT can be helpful in more complex or comminuted fractures when the number and position of fragments need to be defined more precisely or when surgery is being planned. Ultrasound does not replace radiographs for diagnosing an acute adult fracture, although it can complement soft-tissue or effusion assessment in selected situations.
What does the Mason classification mean?
In simplified terms, Mason type I describes a fracture without substantial displacement, type II a displaced fragment involving part of the radial head, and type III a comminuted fracture. In the Johnston modification, type IV refers to a radial head fracture associated with elbow dislocation.
The classification is useful for describing the injury, but it does not choose the treatment by itself. Two fractures within the same category may differ in stability, available motion and associated damage.
When can treatment be non-operative?
Non-operative management is appropriate mainly for nondisplaced and minimally displaced fractures when the elbow is stable and there is no mechanical block to motion. This is typical for Mason type I fractures and also applies to many carefully selected isolated Mason type II injuries.
A key goal is to avoid unnecessary elbow stiffness. If fracture and joint stability permit, controlled range-of-motion exercises are introduced after a short period of protection. The exact timing and progression of loading depend on the injury pattern rather than a single fixed timetable for every patient.
A randomized trial of 45 adults with isolated Mason type II fractures found no significant one-year functional advantage of screw fixation over non-operative treatment. A 2026 meta-analysis involving 181 patients likewise found no clear operative advantage in function or range of motion. The evidence remains limited, however: the meta-analysis included only four studies, just one of which was randomized, and some analyses were heterogeneous.
Does displacement of more than 2 mm mean surgery?
No. A review in EFORT Open Reviews emphasizes that displacement beyond 2 mm, in the absence of a mechanical block to pronation or supination, is not by itself an unequivocal indication for surgery.
What matters is the overall pattern: fragment size and position, remaining bony contact, comminution, unrestricted motion, joint stability and associated injuries. Treatment should therefore not be decided from a millimetre measurement in a radiology report alone.
When is surgery more likely to be needed?
- A true mechanical block to forearm rotation — a bony fragment prevents pronation or supination rather than motion being limited only by pain.
- Marked comminution of the radial head, particularly when reliable reconstruction is difficult or impossible.
- Loss of elbow stability or an associated dislocation, ligament injury or additional fracture.
- Major displacement with loss of fragment contact, especially when other features of a complex injury are present.
- A situation in which acceptable elbow anatomy and function cannot be restored with non-operative treatment.
In a complex injury, preserving or reconstructing the radial head may be important for joint stability. Simply removing an inconvenient fragment is therefore not a universal solution.
What does surgery involve?
If the fracture can be anatomically reconstructed, open reduction and internal fixation is commonly performed with screws and, in some patterns, a plate. If a severely comminuted fracture cannot be reconstructed reliably and the radial head is needed for elbow stability, radial head replacement may be considered.
The choice of procedure depends on the entire injury pattern. There is no single operation that is appropriate for every radial head fracture.
Return to function
Loss of motion is one of the main problems after elbow injury. When the fracture and the joint are stable, the aim is therefore to begin controlled movement as early as safely possible. Heavier loading, lifting and return to sport require adequate healing progress and restoration of function.
Recovery speed depends on the fracture pattern, associated injuries, treatment method and individual response. The absence of pain at rest does not by itself mean that the bone is fully healed or ready for high loads.
When is urgent assessment needed?
- the elbow is visibly deformed or dislocation is suspected,
- there is an open wound or exposed bone,
- the hand becomes pale, blue or clearly colder than the other hand,
- numbness, finger weakness or other neurological symptoms are increasing,
- pain and swelling are rapidly worsening despite protection and analgesia,
- forearm rotation is essentially impossible or there is a clear mechanical block,
- the forearm or wrist also hurts, suggesting that more than one structure may be injured.
Key point for an orthopaedic surgeon
A radial head fracture does not automatically require surgery. Stable, isolated fractures without a mechanical block often do well with non-operative treatment and early controlled motion. Mechanical blockage, comminution, instability and associated injuries are usually more important than a single displacement measurement. The whole elbow and upper limb therefore need to be assessed, not just one fragment on an image.
References
- van der Windt AE, Langenberg LC, Colaris JW, Eygendaal D. Which radial head fractures are best treated surgically? EFORT Open Reviews. 2024;9(5):413–421. DOI: 10.1530/EOR-24-0035.
- Goy C, van de Wall BJM, Beeres FJP, et al. Operative vs. nonoperative treatment in Mason type II fractures: a meta-analysis. JSES Reviews, Reports, and Techniques. 2026;6(3):100773. DOI: 10.1016/j.xrrt.2026.100773.
- Mulders MAM, Schep NWL, de Muinck Keizer RJO, et al. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2021;30(7):1670–1678. DOI: 10.1016/j.jse.2021.02.025.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.