Early Functional and Radiological Outcomes of Radial Head Replacement in the Management of Radial Head Fractures: A Prospective Study

Background Radial head fractures, particularly Mason type III and IV, often require radial head replacement (RHR) to restore elbow stability and function when fractures are unreconstructable. This study evaluates the short-term functional and radiological outcomes of RHR in managing complex radial head fractures Methods A prospective study was conducted from January 2023 to January 2025 at Government Medical College, Amritsar, India, involving 25 patients with Mason type III (n=21, 84%) and type IV (n=4, 16%) radial head fractures treated with monopolar cemented RHR. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS) at 6, 12, and 24 weeks post-surgery, while radiological outcomes evaluated prosthesis stability, alignment, and complications. Statistical analysis included Fisher's exact test for categorical variables and t-tests/ANOVA for continuous variables (p<0.05). Results The mean age was 40.2 ± 13.5 years (16, 64% male). The mean MEPS improved from 76.2 ± 12.2 at six weeks to 87.8 ± 12.1 at 24 weeks (p<0.001), with 11 (44%) achieving excellent (MEPS ≥90) and 12 (48%) good (MEPS 75-89) outcomes. Stable prosthesis alignment was achieved in all patients by 12 weeks (mean 8.1 ± 1.4 weeks). Complications occurred in eight (32%), including infection in two (8%) and stiff elbow in two (8%), with no significant association with Mason type (p=0.275). No significant difference in MEPS was observed between Mason type III and IV fractures (p=0.523). Conclusion RHR is effective for Mason type III and IV radial head fractures, yielding good functional outcomes and reliable prosthesis stability with a notable complication rate. Addressing associated injuries is crucial for optimizing outcomes. Larger studies with longer follow-up are needed to assess long-term prosthetic durability.