Radial head resection is the accepted treatment of comminuted radial-head fractures in adults, but the results are not always satisfactory. This study examines the results of silicone replacement arthroplasty of the radial head in acute fractures and as a salvage procedure after failed resections of the radial head. The first group of patients was evaluated both before and after silicone replacement arthroplasty had been done as a salvage procedure following a previous radial head fracture. This group comprised twelve patients with an average follow-up of 3.8 years. Improvement was found in a number of parameters, including supination and grip strength. The second group of patients had had a primary silicone replacement arthroplasty following a comminuted radial-head fracture. This group was composed of six patients with an average follow-up of 3.6 years. The radial head implant was found to provide a spacer effect that maintained good radiocapitellar contact and prevented radial shortening. Silicone replacement arthroplasty has a role as a useful, safe, and reliable alternative in the treatment of comminuted radial-head fractures in adults and as a salvage procedure in patients with failed radial-head resections. This is especially true in young, active individuals, who were found to be at the greatest risk of failure after radial head resection alone. This was attributed to greater demands being placed on the involved extremity.