Radial head reconstruction using a capitellum graft

Background: Radial head fractures represent 30% to 40% of elbow fractures, often occurring via indirect trauma. As a primary stabilizer of the elbow, the radial head requires anatomical preservation, particularly in cases of complex joint instability involving ligamentous injury. When internal fixation is unfeasible due to significant bone loss, current management typically involves radial head excision or prosthetic replacement, though both options present specific biomechanical and availability challenges.

Objective: This article describes an alternative surgical technique using an autologous osteochondral graft harvested from the lateral humeral condyle (capitellum) to reconstruct the radial head in acute traumatic settings.

Key Points: Morphometric studies indicate a strong correlation between capitellar diameter and radial head size, supporting the use of the capitellum as a donor site. The technique involves a lateral approach to the radiohumeral compartment, followed by the harvesting of a 4–5 mm thick sagittal graft from the capitellum. This graft is then transposed to the radial head to address circular bone defects and secured using mini-screw fixation or a console plate within the "safe zone." Clinical cases demonstrate successful graft integration and consolidation at 18 months, with restored range of motion in flexion-extension and pronation-supination.

Conclusion: Anterolateral capitellar autografting provides a viable strategy for radial head reconstruction when primary repair is precluded by bone loss. This technique facilitates anatomical restoration using local tissue, avoids the requirement for prosthetic implants, and achieves satisfactory functional outcomes in complex elbow dislocations.