Early reports of open reduction and internal fixation of fractures of the radial head were positive, perhaps because of the prevalence of isolated partial head fractures for which good results would be expected. Subsequent reports have found that complex fractures of the radial head are prone to early failure, nonunion, and poor forearm rotation after operative fixation. Combined with increased availability and use of metal radial head prosthesis for complex fractures of the radial head, the role of open reduction and inter-nal fixation is being redefined.