Radial head fracture
This page is for adult patients; see radial head fracture (peds) for pediatric patients
Background
- Most common fractures of the elbow, approximately 20% of elbow fractures
- Caused by FOOSH in pronation leading to radial head being driven into the capitellum
Associated injuries (are common)
- Capitellum fracture
- Olecranon fracture
- Coronoid fracture
- MCL injury
- Elbow dislocation
- DRUJ (distal radial ulnar joint) injury
- Interosseous membrane disruption
- Essex-Lopresti fracture (radial head fracture, DRUJ, interosseous membrane disruption), requires ORIF
- Terrible triad (radial head fracture, coronoid fracture, elbow dislocation)
Clinical Features
- Pain in the lateral elbow, especially with pronation/supination of forearm
- Swelling laterally and tenderness of radial head
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
Workup
- Elbow PA & lateral
- Consider x-rays of humerus, forearm, and wrist (e.g. to rule out a Essex-Lopresti fracture)
- Consider Greenspan (radial head-capitellum) view X-Ray
- Lateral elbow is shot at 45 degrees to pick up subtle fractures
Diagnosis
- Ensure there is no tenderness over the rest of the forearm/wrist to rule out an Essex-Lopresti fracture
- Typically diagnoses on x-ray (fractures are often subtle)
- Look for abnormal fat pad
- Look for radiocapitellar line disruption
- See elbow X-ray
Management
- Sling immobilization in flexion, ice, elevation
- Nondisplaced fracture with no mobility restrictions: ortho follow up within 1wk
- Displaced fracture or mobility restrictions: ortho follow up within 24hr
Disposition
- Normally outpatient