Management of Radial Head Fractures in Complex Elbow Injuries: An Expanded Comprehensive Review
Keywords:
Radial Head Fracture, Terrible Triad of The Elbow, Elbow Fracture-Dislocation, Radial Head Arthroplasty, Open Reduction Internal Fixation (ORIF),, LUCL Reconstruction, Coronoid Fracture, Elbow InstabilityAbstract
Radial head fractures are a pivotal component of complex elbow instability, particularly within the context of fracture-dislocations and the terrible triad of the elbow. These high-energy injuries involve combined osseous and ligamentous disruption, posing significant challenges in diagnosis, surgical planning, and long-term functional outcomes. The radial head plays a critical biomechanical role in load transmission (40–60%), valgus stability, and proximal radial alignment, rendering its structural integrity essential for normal elbow kinematics and forearm rotation. This expanded comprehensive review synthesizes current evidence on the epidemiology, anatomy, biomechanics, classification systems, imaging modalities, treatment algorithms, surgical techniques, rehabilitation protocols, and complications associated with radial head fractures in complex elbow injuries. Special emphasis is placed on decision-making in polytrauma patients, osteoporotic bone, revision scenarios, and emerging technologies. A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies published between January 2000 and June 2024. Keywords included radial head fracture, elbow instability, terrible triad, ORIF, radial head arthroplasty, LUCL reconstruction, coronoid fracture, and elbow dislocation. Priority was given to randomized controlled trials (RCTs), meta-analyses, prospective cohort studies, clinical guidelines, and biomechanical investigations. The incidence of radial head fractures ranges from 3 to 10 per 100,000 person-years, with a peak in adults aged 30–60 years following a fall on an outstretched hand (FOOSH). In complex injuries, associated lesions include lateral ulnar collateral ligament (LUCL) rupture (up to 85%), coronoid fractures (70%), and medial collateral ligament (MCL) insufficiency (30%). Non-displaced fractures (Mason I) are typically managed conservatively. Displaced but reconstructible fractures (Mason II) benefit from open reduction and internal fixation (ORIF). Comminuted fractures (Mason III/IV), particularly in unstable elbows, require radial head arthroplasty, as isolated excision leads to valgus instability, proximal radial migration, and progressive radiocapitellar arthritis. Modern modular prostheses allow precise anatomical restoration of radial head height, diameter, and neck angle, minimizing complications. Combined bony and soft tissue reconstruction—radial head replacement, LUCL reconstruction, and coronoid fixation—restores stability in over 90% of cases. Emerging techniques include arthroscopic-assisted fixation, 3D-printed patient-specific implants, biologic augmentation with platelet-rich plasma (PRP), and robotic-assisted implant alignment. Successful management of radial head fractures in complex elbow injuries demands a structured, protocol-driven approach integrating accurate imaging, biomechanical understanding, timely surgical intervention, and early controlled rehabilitation. Adherence to established treatment algorithms significantly improves functional outcomes and reduces complication rates. Future directions include enhanced implant longevity, regenerative medicine strategies, and integration of artificial intelligence in preoperative planning.
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