Objective        To compare the clinical outcome of radial head resection with radial head prosthesis replacement in the treatment of irreparable radial head fractures.       Methods       Clinical date of 77 radial head fractures cases (77 elbows) receiving radial head excision and radial prosthesis in our department from June 2000 to August 2013 were collected and retrospectively an

alyzed. Finally

only 56 cases were identified and followed up effectively

including the resection group (n=35) and the replacement group (n=21). The last follow-up were assessed in regard of radiographic findings

range of motion

Hospital for Special Surgery (HSS) functional rating scores

the Disabilities of the Arm

Shoulder and Hand (DASH) questionnaire and visual analogous scale (VAS) of pain.       Results       The average time of follow-up was 72 months (ranging from 14 to 156) for the resection group

and was 38 months (ranging from 7 to 100) in  the replacement group. No dislocation

infection

or loosening was seen in the replacement group

but 2 cases of heterotopic ossification was found

while 3 cases of heterotopic ossification were founded in the resection group. Significant difference was seen in the HSS functional rating score between the resection and replacement groups (85.4±7.5 vs 91.3±5.6 points

P

0.05)

but not seen in the score of DASH (16.5±5.1 vs 13.6±6.2

P

0.05). Elbow motion averaged 3°(extension loss) to 132°(flexion) in the resection group

and 5° to 131° in the replacement group

while pronation-supination of the forearm averaged 74° to 71° in the former group

and 81° to 82° in the later (

P

0.05). In comparison with the value for the contra-lateral limb

the average increase in the carrying angle was (6.30±2.36)°  in the resection group and (1.72±1.03)°  in the other group with significant difference between them (

P

0.05). The VAS scale was lower in the replacement than the other group.       Conclusion        Radial head replacement is an optimal approach for postoperative patients with irreparable radial head fractures due to comminuted fracture or old injury to maintain the stability and function of elbow joint.