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 anasthetic agent). Type 3 always cause a mechanical block.
- 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.
At times it may be possible to reconstruct the radial head in patients with posterior dislocation of the elbow and a coronoid fracture. In such patients at the time of radial head reconstruction the coronoid should be fixed and the torn ligaments of the elbow joint should be repaired.
This is a x ray of a patient with elbow dislocation along with a fracture of radial head (orange arrow) and a fracture of the coronoid. The coronoid fracture is a small triangular fragment shown by the yellow arrow.
- 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.
In this photo the subject is using his right hand to fully supinate (palm facing upwards) his left hand.
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.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 11th February 2009.
Other causes of elbow pain...
Little League Elbow
Lateral Condyle Fracture
Elbow Joint Anatomy
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