Overview of Radial Head Elbow Fracture

A radial head fracture is the most common type of elbow fracture that occurs in adults. This type of injury is most commonly caused by a fall onto an outstretched hand. Radial head fractures occur most often in two groups of patients: elderly women as a result of osteoporosis or young men as a result of significant trauma.

They can also occur in other groups of patients, but these two groups are by far the most common. In addition, radial head fractures can occur in conjunction with other elbow and upper extremity trauma.

The radial head is shaped like a round disc and is important in movements of the elbow. The radial head moves both in flexion and extension (bending) of the elbow joint, as well as rotation of the forearm. Therefore, injury to the radial head can affect all movements at the elbow.

Symptoms

Radial head fractures most often occur after falling and reaching out to brace yourself with your forearm. The symptoms of this type of fracture include:

• Pain at the elbow
• Limited range-of-motion of the joint
• Swelling of the joint
• Tenderness mostly on the outside of the joint

Diagnosis

Radial head fractures can often be seen on an X-ray, but sometimes in well-aligned breaks of the bone, they may not show up on a regular X-ray. Often the injury is suspected if swelling is seen on the X-ray within the elbow joint. Other tests, such as a CT scan or an MRI, can be obtained if there is the uncertainty of the diagnosis.

Treatment of Injury

Treatment of radial head fractures depends on the appearance of the fracture on X-ray. Radial head fractures that are not badly displaced can be managed by splinting the elbow for a short period of time to control discomfort, followed by early range-of-motion exercises. More prolonged immobilization is not recommended and can lead to more problems resulting from the stiffness of the joint.

More significantly displaced radial head fractures may require surgery for stabilization of the fracture, or possibly an excision of the radial head. Determining which type of treatment is appropriate depends on several factors including the number of bone fragments, injury to other bones and ligaments around the elbow, and activity level of the patient.

If the radial head requires removal, an implant may need to be put in its place to prevent elbow instability. This procedure called a radial head replacement is necessary if other bones and/or ligaments have been injured and the elbow joint is unstable without any radial head. Otherwise, removal of an isolated radial head injury usually does not cause any impairment in the function of the elbow joint.

Complications of radial head fractures include nonunion, malunion, elbow arthritis, and stiffness of the elbow joint. Nonunion (unhealed fractures) and malunion (poorly aligned fractures) are most common with non-surgical treatment, but can often cause no symptoms. Arthritis and stiffness are more common with more severe injuries, such as fractures that cause many pieces of the bone.