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Radial Head Fracture: Diagnosis, Classification and Treatment

Radial head fracture is a fracture of the upper end of the radius bone where it articulates with the lower end of the humerus bone. It can result from

fall on the outstretched hand
along with dislocation of the elbow joint

Before reading further please see the Elbow Joint Anatomy to get a better understanding (skip if you have already done so).

It can be classified into three types

Type 1 are undisplaced or minimally displaced fractures (less than 2mm or 1/4th diameter of the neck)
Type 2 are partially displaced fractures (more than 2mm or 1/4th the diameter of the neck)
Type 3 are comminuted fractures (multiple fracture fragments)

Along with radial head fracture other injuries that may be present include

posterior dislocation of the elbow joint
tear of the interosseous ligament of the forearm (Essex-Lopresti injury)
fracture of the upper ulna shaft (Monteggia fracture)
fracture of the coronoid process of ulna

They can be present with any type of radial head fracture. There presence indicates a more severe injury.

Type 1 does not cause any mechanical block to the movement of the radial head. Type 2 may cause a mechanical block (tested by gentle supination and pronation after infiltrating a local anaesthetic agent). Type 3 always cause a mechanical block.

Symptoms include

history of trauma
pain in the outer aspect of the elbow joint
mild swelling may be present
movements of the elbow joint may be painful and limited
wrist pain may be present (indicates a Essex-Lopresti injury)

Type 1 fracture may present as elbow pain only without any swelling.

Diagnosis can be confirmed by x rays and CT scan of the elbow joint

Treatment is according to classification of the fracture.

Type 1 fractures are treated by using a plaster splint for one week along with anti-inflammatory medication. After one week a removable splint is applied.

For a few hours every day the patient removes the splint and exercises the elbow joint gently. This is continued for 2 weeks after which the splint is completely removed and the patient is now encouraged to fully use his limb.

Type 2 fractures with mechanical block are treated by surgery. During surgery the fracture fragments are aligned and fixed with screws. Fractures without mechanical block are treated as type one fractures.

Type 3 fractures are treated by excision of the head of radius. Excision is done as it is not possible to reconstruct the radial head. Excision should be avoided if a Essex-Lopresti injury is suspected or if there is a posterior dislocation of the elbow or a coronoid fracture.

Excision in these patients can result in up ward migration of the radius and instability of then elbow joint respectively. Delayed excision (after few months) is preferred in these situations.

Complications include

loss of movement of the elbow
arthritis of the proximal radio-ulnar joint and the radio-humeral joint
proximal migration of the radius following migration of the radius bone

Frequently Asked Questions

How can I minimise loss of movement of the elbow joint after radial head fracture?

Loss of movement can be minimised by early and persistent physiotherapy.

What exercises should I do after the radial head fracture has united and the splint is removed?

There are many simple exercises that you can do. Here I will tell you the ones that will increase the movement of supination and pronation or simply palm facing up and palm facing down. This is the main movement that is lost after radial head fracture. Exercises include

With your elbow flexed to 90 degrees turn your palm to face up, don't move your shoulder. If your palm doesn't face completely up wards then take the help of your other hand and gently apply some force to make your palm face slightly more upwards. This might result in some pain in the elbow. (see graphic below)
Don't worry, gently apply the force with your opposite hand within the tolerable limits of pain. Rest for a few seconds and repeat now trying to face the palm down wards.
Continue as long as you wish and repeat many times in a day.
Take a wide mouth container from your kitchen with a screw able lid. Now unscrew and screw it back on. Repeat many times a day.
You can also try turning a door knob (not handle).

You should also put all the other joints of your upper limb through their full range of motion. Move your fingers, wrist and shoulder.

$radial head fracture exercise$ In this photo the subject is using his right hand to fully supinate (palm facing upwards) his left hand.

$radial head fracture exercise$ This photo shows the subject using his right hand to pronate (palm facing downwards) the left hand.

If I develop arthritis of the proximal radio-ulnar joint and the radio-humeral joint what treatment options do I have?

Treatment options you have include

occasional analgesics (recommended if the symptoms are off and on and mild; and there is low demand on the elbow joint)
excision of the radial head (recommended if the symptoms are severe and persistent)

Before excision is done it must be very clear that proximal (up ward) migration of the radius can occur after excision.

What is the treatment for proximal migration of the radius?

The orthopaedic community has yet to find a satisfactory treatment for this condition. Treatment options available are

shortening of the ulna (the radius still continues to migrate proximally)
fusion of the radius to the ulna (severely limits the movement of the forearm)

The good thing is that most patients have few symptoms in spite of the proximal migration of the radius.

Other causes of elbow pain...

Supracondylar Fracture

Lateral Condyle Fracture

Elbow Joint Anatomy

Go back from Radial Head Fracture to Elbow Pain

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