The injury films represent a highly comminuted radial head fracture, which when treated with ORIF, is likely to have a poor outcome especially in the delayed setting. In the absence of DRUJ and elbow instability, and no wrist tenderness, radial head resection is the best treatment option. While a radial head prosthesis may theoretically prevent proximal radial head migration that can occur with radial head excision, this is unlikely in an isolated radial head fracture without other ligmentous injury (elbow ligaments, interosseous membrane or DRUJ).
Herbertsson et al (March, 2004) reported on 100 patients with Mason II and III radial head fractures. Nine of those initially treated nonoperatively had continued pain and underwent late radial head excision with good results.
In another report by Herbertsson et al (September, 2004) the authors report on radial head excision in both an acute and delayed setting and found fair-good results for most patients in both subgroups.
Jackson et al present a review article on radial head fractures where management and operative technique are discussed.
Herbertsson P, Josefsson PO, Hasserius R, Karlsson C, Besjakov J, Karlsson M. Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study. J Bone Joint Surg Am. 2004 Mar;86-A(3):569-74.
PMID:14996884 (Link to Abstract)
Jackson JD, Steinmann SP. Radial head fractures. Hand Clin. 2007 May;23(2):185-93, vi.
PMID:17548010 (Link to Abstract)
Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am. 2004 Sep;86-A(9):1925-30.
PMID:15342754 (Link to Abstract)