Asian Journal of Orthopaedic Research

Traumatic radial head fractures are common elbow injuries and frequently coexist with ligament disruption, coronoid fractures, elbow dislocation, or longitudinal forearm instability. In these complex settings, the radial head acts as an important secondary stabilizer against valgus and posterolateral rotatory instability and contributes to axial load transmission across the radiocapitellar joint. When fixation is not feasible—most often in comminuted Mason type III and selected type IV patterns—surgeons must choose between radial head excision and radial head arthroplasty. Historically, excision offered pain relief and improved motion in selected patients, but concerns persist regarding proximal radial migration, valgus instability, late degenerative change, and compromised forearm mechanics, particularly when occult interosseous membrane or distal radioulnar joint injury is present. Arthroplasty has evolved substantially with modular designs and improved sizing strategies, aiming to restore elbow and forearm stability in fracture-dislocation patterns; however, it introduces implant-specific complications such as loosening, overstuffing, stiffness, heterotopic ossification, and reoperation for pain or limited motion. This review synthesizes contemporary evidence on indications, functional outcomes, complications, and revision patterns after radial head excision versus arthroplasty in traumatic radial head fractures, emphasizing injury-pattern–based decision-making and technical pitfalls that influence prognosis.