This 1954 paper by Mason reviews 100 cases of radial head fracture to evaluate outcomes of conservative versus operative treatment. It proposes a three-type classification based on displacement and comminution, and defines the threshold at which surgical excision is warranted. The classification and operative axiom it established remain foundational to how radial head fractures are taught and managed.
When you evaluate a radial head fracture, two questions drive management: How much of the articular circumference is involved? Is the fragment tilted?
Mason's series shows that the one-quarter circumference threshold is the practical operative decision point. Fractures under this limit without tilt do well conservatively. Beyond it, conservative management reliably produces 60° of rotation loss — a functionally significant deficit that prevents heavy labor and forces patients to lighter-duty work.
The paper's operative axiom. 'if in doubt, resect'. Reflects that the proximal radioulnar joint is a tightly fitted pivot that tolerates minimal mechanical distortion. Fragment tilt matters more than fragment size alone, and oblique radiographic views are necessary to avoid underestimating true circumferential involvement.
For boards and clinical practice, remember that persistent extension loss after radial head fracture is caused by humero-ulnar joint cartilage injury, not the radial head. This is why excision does not restore full extension: the damage is in the medial compartment from the initial valgus loading, not at the radiocapitellar joint.
This 1954 paper by Mason reviews 100 cases of radial head fracture to evaluate outcomes of conservative versus operative treatment. It proposes a three-type classification based on displacement and comminution, and defines the threshold at which surgical excision is warranted. The classification and operative axiom it established remain foundational to how radial head fractures are taught and managed.
When you evaluate a radial head fracture, two questions drive management: How much of the articular circumference is involved? Is the fragment tilted?
Mason's series shows that the one-quarter circumference threshold is the practical operative decision point. Fractures under this limit without tilt do well conservatively. Beyond it, conservative management reliably produces 60° of rotation loss — a functionally significant deficit that prevents heavy labor and forces patients to lighter-duty work.
The paper's operative axiom. 'if in doubt, resect'. Reflects that the proximal radioulnar joint is a tightly fitted pivot that tolerates minimal mechanical distortion. Fragment tilt matters more than fragment size alone, and oblique radiographic views are necessary to avoid underestimating true circumferential involvement.
For boards and clinical practice, remember that persistent extension loss after radial head fracture is caused by humero-ulnar joint cartilage injury, not the radial head. This is why excision does not restore full extension: the damage is in the medial compartment from the initial valgus loading, not at the radiocapitellar joint.