An adult sustains a comminuted fracture of the radial head involving the entire head with marked displacement. On examination there is crepitus and block to pronosupination. According to the Mason classification, this is a Type III lesion. The preferred current management is:

• A Above-elbow plaster cast for 4 weeks
• B Excision of the radial head without replacement
• C Radial head arthroplasty with repair of associated ligament injury ✓
• D Radial head excision combined with proximal ulna osteotomy

Explanation

Mason Type III is a comminuted fracture of the entire radial head that cannot be internally fixed. Because the radial head is an important secondary stabiliser against valgus and longitudinal forces, especially if the medial collateral ligament or interosseous membrane is torn, simple excision risks proximal migration of the radius and cubitus valgus. Current practice therefore favours metallic radial head arthroplasty with repair of associated ligamentous injury. Isolated cast immobilisation leaves a mechanical block to rotation.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.