The Mason type III and IV radial head fractures are severe injuries that lead to decreased range of motion, alteration in the kinematics, the load transfer and the stability of the elbow. They are often in conjunction with ligament injuries, anterior or posterior joint dislocations and fractures of the coronoid process, the humeral capitulum and the olecranon. The resection of the head leads to elbow instability, late complications and arthrosis of the elbow. The open reduction and internal fixation (ORIF) in Mason type III and IV fractures is not able to restore and sustain the anatomical structure and function of the radiocapitellar joint. That is why these fractures require arthroplasty. The best results are reported with the use of metal bipolar prosthetics. We present our initial experience with radial head arthroplasty on three patients with mean follow up 18 months and a review of the English literature.