Radial head fractures are common elbow injuries with the highest incidence in middle-aged to older women after low-energy falls and younger men after sports and high-energy trauma. Radial head fractures directly impair elbow biomechanics by reducing valgus stability, altering load transmission, and increasing the risk of instability, particularly when associated with ligament injuries. The importance of the radial head in elbow biomechanics has become increasingly recognized, and it has influenced the approach to fracture management. The Mason classification, with the Hotchkiss modification, is the most widely used system for classification of radial head fractures. Additionally, associated injuries must always be recognized as they influence the treatment. Nondisplaced and minimally displaced fractures (type I) are managed nonoperatively. Management of displaced and comminuted fractures (type II and type III) remains controversial. Ability to achieve a successful reconstruction and elbow stability are key factors when decision about the treatment is made. Surgical treatment continues to represent technical challenges to the surgeon.