Radial Head Fracture

Have you sustained a radial head fracture?  Fractures of the radial head are a more common type of elbow fracture.  What can you expect if you’ve sustained this type of fracture?  Is surgery necessary?  Will you regain normal use of your elbow?  Learn more about what to expect and how you can obtain the best outcome possible.




What Is A Radial Head Fracture?

The elbow is comprised of three bones:  the humerus, radius, and ulna. The humerus is the bone of the upper arm that helps to form the elbow below and the shoulder above.  The two bones that form the forearm include the radius, located on the thumb side of the forearm, and the ulna on the pinky side.  The head of the radius is located just below the elbow on the thumb side and functions to roll over the ulna as you rotate your forearm from palm up to palm down.  A radial head fracture is thus a fracture to this part of the radius. 


 
Causes and Diagnosis

Most fractures to the radial head occur through some type of a trauma.  The most common is landing on an outstretched arm.  Radial head fractures often occur in conjunction with elbow dislocations.   

As part of the evaluation of the elbow, a physical exam including testing the ability to move the elbow, wrist, and fingers is necessary.   Because of the location of the nerves as they pass through the elbow, testing both motor (active motion) and sensory (ability to feel pressure, light touch, temperature) ability should be performed.   Ligament stability testing will also be incorporated in order to help determine if any damage to the ligaments has occurred.

In order to determine if a fracture has occurred, an x-ray will need to be performed.  The x-ray will help to determine the severity of the injury and if surgery will be necessary.   If injuries to the ligaments or nerves are suspected, an MRI may also be recommended.    



Best Treatment

Treatment for a radial head fracture will be determined by the severity of the fracture.  If the fracture is small or most importantly, not displaced, treatment will involve immobilization in either a splint or sometimes a cast.  A sling is generally also used during this time to help support the arm.   The period of immobilization will generally be at least 2-3 weeks.  Although fractures take 6-8 weeks to heal, immobilizing for the entire healing time is not generally recommend as elbows have a tendency of developing stiffness, thus early movement is often recommended.    

If a splint is utilized instead of a cast, other forms of treatment can be utilized during the protection phase.  Utilizing ice as well as light range of motion and isometric exercises can assist in minimizing elbow stiffness, muscle weakness, pain and swelling. 

If however the fracture is unstable, surgery will be necessary.  A procedure called an ORIF (open reduction, internal fixation) that utilizes pins or plates will be performed to stabilize the fracture.   In addition, if ligament damage also occurred as a result of the injury, the surgical repair of any ligaments will also be performed. 



Following a period of immobilization, physical therapy will be suggested.   Regaining full elbow extension and supination (the ability to rotate your palm up) is often the challenge following a period of elbow immobilization.  Physical therapy would focus on restoring normal elbow range of motion, strength, and function. 

Primary issues following surgery for a fracture of the radial head include lingering stiffness in the joint and an inability of the fracture to fully heal.  Following surgeon and physical therapy recommendations will help in decreasing the potential of these negative results. 


Summary

  • The radial head is located just below the elbow on the thumb side and functions to help the forearm rotate.
  • Fractures of the radial head can be associated with other injuries including dislocations, ligaments, and nerves.
  • Falls on an outstretched arm is the most common cause.
  • Physical exam, x-rays, and an MRI will be necessary for diagnosis.
  • For small and stable fractures, treatment involves a short period of immobilization followed by physical therapy.
  • For large and unstable fractures, surgery, immobilization, and physical therapy are the best treatment options.  


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References

J Hand Surg Am.  2012 Dec; 37(12):2626-35.

Radial head fractures.

Yoon A., Athwal GS, Faber KJ, King GJ.

 

Acta Orthop Belg. 2012 Oct; 78(5): 597-602

Nonunion of the radial neck following operative treatment for displaced radial head and neck fractures.

Kang HJ, Shin SJ, Kang SS.

 

J Orthop Trauma. 2012 July 11.

Comparison of early mobilization protocols in radial head fractures. A prospective randomized controlled study. The effect of fracture characteristics on outcome.

Paschos NK, Mitsionis GI, Vasiliadis HS, Georgoulis AD.