What This Procedure Involves
An incision is made over the lateral (outer) elbow using a Kocher approach. The radial head is exposed and excised at the level of the radial neck. The remaining bone is smoothed. The operation takes 30–45 minutes.
Radial head excision is an operation to remove the radial head — the top of the radius bone at the elbow. It is performed for severely comminuted radial head fractures that cannot be fixed, chronic post-traumatic arthritis, or rheumatoid elbow disease.
An incision is made over the lateral (outer) elbow using a Kocher approach. The radial head is exposed and excised at the level of the radial neck. The remaining bone is smoothed. The operation takes 30–45 minutes.
Excision is considered when the radial head is shattered beyond repair (Mason type III/IV) and radial head replacement is not suitable, for chronic post-traumatic arthritis of the radiocapitellar joint, and in rheumatoid arthritis with a painful, eroded radial head.
Radial head replacement (the preferred alternative for acute fractures to maintain lateral column stability), physiotherapy, injection, and activity modification.
X-rays and CT to assess the fracture or arthritis. Assessment of elbow stability — the MCL must be intact. If the MCL is torn, radial head replacement is preferred to maintain stability.
Pain relief and improved forearm rotation. Good results for isolated radiocapitellar arthritis. However, long-term consequences of radial head excision must be understood.
Over time, the radius may migrate proximally (toward the elbow), altering wrist mechanics.
Loss of lateral column support may cause the elbow to become unstable, particularly if the MCL is compromised.
Proximal migration may cause ulnocarpal abutment at the wrist.
The nerve wraps around the radial neck. Risk approximately 1-3%.
New bone formation.
Particularly in the context of multi-ligament injury.
Wound infection.
General or regional anaesthesia.
Early active elbow movement from day one. Sling for comfort for a few days only. Return to desk work within one to two weeks. Full recovery six to eight weeks.
Review at two weeks and six weeks. Long-term monitoring for proximal radial migration.
Radial head replacement is generally preferred for acute fractures to maintain lateral column stability. Excision without replacement is reserved for chronic conditions where the elbow is otherwise stable.