Radial Head Fracture

The radius is one of the two bones in the forearm, and the radial head is the end of the radius bone that makes up the elbow joint. Radial head fractures often occur when trying to brace yourself with your hands while falling. The force of the impact travels up the forearm to the elbow, potentially causing a fracture, dislocation, or both. They are one of the most common elbow fractures and occur most frequently in people between 30 and 40. They are more often seen in women than men.

Symptoms of a radial head fracture include:

• Pain
• Swelling of the elbow
• Difficulty bending or straightening the elbow
• Difficulty turning the forearm up or down

Types of fractures:

Radial head fractures are classified by how displaced the fracture fragments are. Fractures that are not very displaced or not displaced at all usually go on to heal well without surgical intervention.

Some fractures may cause a mechanical block when bending or straightening the elbow, or when turning the forearm. These fractures may benefit from surgery with the goal of restoring range of motion.

Fractures associated with elbow dislocation and ligamentous injury may require surgery to restore the stability of the elbow joint.

Fractures that are severely comminuted or fractured into many pieces may not be reconstructed and could require replacement with an artificial radial head or removal of the radial head entirely.

Diagnosis:

X-rays of the elbow are sufficient to diagnose and classify most radial head fractures. Some fractures are very small and may not appear on an x-ray for at least a week or so from the injury date.

A CT scan may be ordered to evaluate further details of the fracture.

MRI may be used to evaluate soft tissues like ligaments and tendons, which may also be disrupted during an elbow injury.

Non-Operative Treatment:

Fractures that are nondisplaced or minimally displaced are immobilized using a sling for 3-7 days. Range of motion is encouraged relatively quickly to prevent elbow stiffness. Physical therapy may help with reducing stiffness and regaining strength after the injury. The most common complication following non-operative treatment of a radial head fracture is loss of elbow motion.

Operative Treatment:

If a fracture is displaced and inhibits elbow motion, open reduction and internal fixation (ORIF) may be recommended to bring the fracture into better alignment. The fracture is typically held in place with screws or plates. After surgery, the patient may be asked to immobilize the elbow and employ weight restrictions for several weeks until the fracture heals. Physical therapy may be recommended after surgery as well.

In rare situations where the fracture cannot be reconstructed, part of the radial head may be removed (resected), or the radial head can be replaced.

Potential Complications of Surgery:

• Infection
• Arthritis of the elbow joint
• Stiffness of the elbow
• Bleeding
• Damage to surrounding structures. The posterior interosseous nerve (PIN) is at the most risk when operating on or around the radial head
• The growth of bone around the joint is called heterotopic ossification. The risk of heterotopic ossification is greater after severe dislocation of the elbow joint and significant soft tissue injury around the joint.