Between November 1981 and November 1984, eight patients with comminuted radial head fractures were treated with open reduction and internal fixation. The recommended treatment for these fractures has been early motion, with or without radial head excision. According to the AO classification all were B3-1 or B3-2 fractures. All fractures were fixed through Kocher incisions using Kirschner wires and AO small fragment screws. All patients began motion 7 to 10 days following surgery. In a retrospective study, clinical results were reviewed in six patients with an average followup of 12 months (range, 4 to 40 months). Three patients had associated elbow dislocations, one requiring internal fixation of the coronoid process. Loss of range of motion averaged 3 degrees of flexion, 10 degrees of extension, 3 degrees of pronation, and 20 degrees of supination. Cybex testing demonstrated no significant difference in strength between injured and uninjured extremities. The only complication was a transient posterior interosseous nerve palsy. No patient had evidence of any radial shortening. Our findings suggest that open reduction and internal fixation gives satisfactory elbow function and avoids complications of radial shortening, loss of motion, and wrist symptoms that may subsequently occur following radial head excision.