# When to Choose a Radial Head Prosthesis? Indications and Contraindications.
Radial head prostheses have become a reliable solution in orthopedic surgery, especially for complex elbow injuries. But like any medical intervention, they aren’t a one-size-fits-all fix. Knowing when to use a **[radial head replacement](https://www.siiora.com/radial-head-prosthesis/)** and when not to is critical for restoring function, reducing pain, and ensuring long-term success.

## What Is a Radial Head Prosthesis?
The radial head is the top part of the radius bone in the forearm, playing a crucial role in elbow stability and motion. When this area is severely damaged — usually from fractures or trauma — and can’t be repaired effectively with screws or plates, surgeons may replace it with a prosthetic implant. The goal is to restore normal joint mechanics, reduce pain, and allow early mobilization.

## When Should You Consider a Radial Head Prosthesis?
### Comminuted Fractures That Can’t Be Repaired
The most common indication for a radial head prosthesis is a comminuted fracture, where the bone is broken into multiple fragments, that is too complex to fix with conventional internal fixation. In these cases, attempting to piece together tiny fragments often leads to poor outcomes. A prosthesis offers a more predictable result, especially when preserving elbow stability is critical.

### Associated Ligament Injuries
If a radial head fracture is part of a broader injury pattern, such as a terrible triad injury (radial head fracture, coronoid fracture, and elbow dislocation), a prosthesis can help stabilize the joint while the ligaments heal. A stable radial head is vital for maintaining joint congruity and preventing redislocation.

### Failed Previous Fixation or Resection
Sometimes, an initial attempt to fix the radial head fails. This may be due to poor bone quality, implant failure, or nonunion. In such revision cases, replacing the radial head can salvage function. Similarly, if the radial head was previously removed and the patient now has chronic instability or pain, a secondary prosthesis might be considered.

### Complex Elbow Instability
In multi-ligament elbow injuries, or where there is instability due to bone loss or malalignment, a radial head prosthesis can restore the length and shape of the radius, which helps reestablish joint balance and biomechanics.

## When NOT to Choose a Radial Head Prosthesis?
### Simple Fractures Amenable to Fixation
If the fracture involves only two or three fragments that can be anatomically reduced and fixed securely, preserving the native radial head is usually the better choice. The natural bone heals well in many cases, especially in younger patients.

### Isolated Radial Head Resection in Low-Demand Patients
In low-demand, elderly patients with isolated radial head fractures and no signs of elbow instability, simple resection may suffice. A prosthesis in such cases might add unnecessary complexity and cost without a significant functional benefit.

### Poor Soft Tissue Envelope or Active Infection
If the surrounding tissue is severely compromised from infection, burns, or prior surgeries, implanting a foreign body like a prosthesis could worsen the situation. Infection risk increases, and healing becomes unpredictable.

### Skeletally Immature Patients
Radial head prostheses are not suitable for children or adolescents whose bones are still growing. Implanting hardware in growing bone can disturb development and create long-term complications.

## Final Thoughts
Choosing a radial head is a balancing act. It’s not just about the fracture but the whole picture: the ligament integrity, patient activity level, bone quality, and the potential for healing. Done right, a prosthesis can restore near-normal elbow function and let patients return to their daily lives without lingering disability. But used in the wrong setting, it can lead to stiffness, pain, and eventual revision surgery.
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