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Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures.However,diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation.We present the case of a 21-years old female treated with excision after radial head fracture,resulting in elbow instability.The patient underwent revision surgery after four weeks.We believe that ligament reconstruction without radial head substitution is a safe altative choice for Mason Ⅲ radial head fractures accompanied by complex ligament lesions.