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Radial Head Fracture – Causes, Symptoms and Treatment

A radial head fracture is a break at the head of the radius bone, located in the elbow joint. It most commonly occurs after a fall onto an outstretched arm.

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Things worth knowing about "Radial Head Fracture"

A radial head fracture is a break at the head of the radius bone, located in the elbow joint. It most commonly occurs after a fall onto an outstretched arm.

What Is a Radial Head Fracture?

A radial head fracture is one of the most common fractures around the elbow joint in adults. It involves a break at the rounded top of the radius -- one of the two forearm bones -- which forms an important part of the elbow joint. Radial head fractures account for approximately one-third of all elbow fractures and affect men and women at roughly equal rates.

Causes

The most frequent cause is a fall onto an outstretched arm with the elbow slightly flexed. The impact force is transmitted up through the radius and concentrated at the radial head, leading to a fracture. Common scenarios include:

Everyday falls (e.g., slipping on a wet floor)
Sports injuries (e.g., cycling, skiing, or climbing accidents)
Road traffic accidents
Direct trauma to the elbow (less common)

Classification

Radial head fractures are most commonly classified using the Mason Classification:

Type I: Non-displaced or minimally displaced fracture with no mechanical block to movement
Type II: Displaced fracture of a partial segment of the radial head
Type III: Comminuted (shattered) fracture of the entire radial head
Type IV: Any radial head fracture associated with elbow dislocation

Symptoms

Typical symptoms of a radial head fracture include:

Pain on the outer side of the elbow, worsening with movement
Swelling and tenderness over the radial head
Restricted range of motion, particularly with forearm rotation (pronation and supination)
A joint effusion (fluid build-up in the elbow joint) in some cases

Diagnosis

Diagnosis is typically confirmed through the following assessments:

Clinical examination: Palpation of the elbow, assessment of range of motion and joint stability
X-ray imaging: Standard two-view radiographs; minor fractures may occasionally not be clearly visible
Computed Tomography (CT): Used for complex fractures or inconclusive X-ray findings to accurately assess fragment position
Magnetic Resonance Imaging (MRI): Useful for evaluating associated ligament and cartilage injuries

Treatment

Conservative Treatment

For non-displaced or minimally displaced fractures (Mason Type I), non-surgical management is usually sufficient and includes:

Short-term immobilization in a sling or splint for a few days
Early physiotherapy exercises to restore elbow mobility
Pain relief medication (e.g., ibuprofen or paracetamol)
Ice application and elevation of the arm during the acute phase

Surgical Treatment

More significantly displaced or comminuted fractures (Mason Types II to IV) may require surgical intervention. Options include:

Open reduction and internal fixation (ORIF): Realigning and stabilizing bone fragments using screws or plates
Radial head resection: Removal of the radial head when reconstruction is not possible (less commonly performed today)
Radial head arthroplasty: Replacement of the radial head with a prosthetic implant, particularly in complex fractures with elbow instability

Recovery and Prognosis

Recovery depends largely on the severity of the fracture. Uncomplicated Type I fractures typically heal within 4 to 6 weeks. More complex injuries may require several months of rehabilitation. Early physiotherapy is essential to prevent long-term stiffness and loss of function. With appropriate treatment, the overall prognosis is favorable.

References

Duckworth A. D. et al. - Radial head and neck fractures: a meta-analysis. Journal of Bone and Joint Surgery, 2012. PubMed PMID: 22218384.
Broberg M. A., Morrey B. F. - Results of delayed excision of the radial head after fracture. Journal of Bone and Joint Surgery, 1986.
Rineer C. A., Guitton T. G., Ring D. - Radial head fractures: loss of cortical contact is associated with concomitant fracture or dislocation. Journal of Shoulder and Elbow Surgery, 2010. PubMed PMID: 19716730.

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