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Collum Radii – Anatomy and Fractures

The collum radii is the anatomical neck of the radius bone in the forearm, located just below the radial head. Fractures of this region are common and frequently affect children.

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The collum radii is the anatomical neck of the radius bone in the forearm, located just below the radial head. Fractures of this region are common and frequently affect children.

Definition and Anatomy

The collum radii (Latin: neck of the radius) refers to the narrow, cylindrical segment of the radius bone situated immediately below the radial head (caput radii). Located in the proximal forearm, this region forms an important part of the elbow joint. The radial neck connects the radial head to the remainder of the radial shaft and is surrounded by a thin cortical bone layer, making it susceptible to injury.

Clinical Significance

The collum radii is particularly important in clinical practice due to its susceptibility to fractures. Radial neck fractures are among the more common injuries around the elbow and are especially frequent in children and adolescents. They typically result from a fall onto an outstretched hand, in which axial force is transmitted through the radial head to the neck.

Causes of Fractures

Fall onto an outstretched hand: The most common mechanism, particularly in children.
Direct trauma: A direct blow or impact to the elbow.
Sports injuries: For example, in gymnastics, cycling, or team sports.
Osteoporosis: In older adults, even minor trauma can be sufficient to cause a fracture.

Symptoms

Typical complaints following a radial neck fracture include:

Pain on the lateral side of the elbow
Swelling and tenderness over the radial neck
Restricted range of motion at the elbow, particularly with flexion, extension, and forearm rotation (pronation and supination)
Visible deformity in severe fractures

Diagnosis

Diagnosis is primarily established through:

Clinical examination: Assessment of pain, swelling, and limited movement.
X-ray imaging: Standard anteroposterior and lateral radiographs of the elbow are the primary diagnostic tool and reveal the location and extent of the fracture.
Computed tomography (CT): Used in complex fractures or unclear findings to assess fragment displacement in detail.
Magnetic resonance imaging (MRI): Considered when soft tissue or cartilage injuries are suspected.

Classification

Radial neck fractures are commonly classified using the Judet classification in children or the Mason classification in adults. Classification is based on the degree of angulation and displacement, which guides the choice of treatment.

Treatment

Conservative Treatment

Non-displaced or minimally displaced fractures (angulation below 30 degrees and step-off of less than 2 mm) can typically be managed conservatively, including:

Immobilization of the elbow with a splint or cast for 2 to 3 weeks
Pain management with anti-inflammatory medications
Physiotherapy to restore full range of motion after the immobilization period

Surgical Treatment

More significantly displaced fractures require surgical intervention:

Closed reduction: Realignment of the fracture without open surgery, often feasible in children.
Open reduction and internal fixation: Surgical realignment and stabilization of bone fragments using screws, wires, or plates.
Radial head resection or prosthesis: Reserved for non-reconstructable fractures in adults.

Healing and Prognosis

With timely and appropriate treatment, the prognosis for radial neck fractures is generally favorable. Children benefit from a particularly high bone healing capacity due to active bone metabolism. Potential complications include restricted elbow motion, avascular necrosis of the radial head, and, rarely, delayed union.

References

Rockwood CA, Wilkins KE, Beaty JH: Fractures in Children. 8th Edition. Lippincott Williams and Wilkins, Philadelphia 2015.
Morrey BF: The Elbow and Its Disorders. 4th Edition. Saunders Elsevier, Philadelphia 2009.
Duckworth AD, McQueen MM, Ring D: Fractures of the Radial Head. Bone and Joint Journal, 2013; 95-B(2):151-159.

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