The goal of treatment of radial head fracture in adult is a painless, stable elbow with as close to normal motion as possible. Especially, radial head fractures associated with elbow stability or with a mechanical block to elbow motion must be treated operatively. Radial head excision usually provides satisfactory results; however, some patients do poorly with radial head excision because of proximal radial migration and altering mechanics of the distal radioulnar joint. This results in ulnar carpal impaction, resultant pain, and occasionally, decreased range of motion of the forearm and wrist. The treatment of ulnar impaction syndrome after radial head excision is controversial and the outcome of such treatment unpredictable. Prevention of the ulnar impaction syndrome after radial head excision and proximal migration of the radius is far easier than the late treatment. Most of authors recommended that whenever possible, do not excise the radial head but, instead, treat the radial head fracture with open reduction and Herbert screw fixation. We reviewed 5 patients with radial head fracture treated by open reduction and internal fixation with Hervert screw after 1989. Follow-up observation, which averaged 14 months, revealed that no patient developed wrist pain. Range of motion of the elbow and forearm was found to be complete in 4 patients and minimally restricted in one. Four patients were pain free with full activity, and one had mild to moderate pain after heavy labor. All type B2 (4 cases) classified by AO classification was excellent, type Cl (1 case) was good result.