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.
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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