Radial head fracture

This page is for adult patients. For pediatric patients, see: radial head fracture (peds).

Background

Left elbow-joint with anterior and ulnar collateral ligaments

• 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
  • Essex-Lopresti 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

Radial head fracture seen on 3D CT reconstruction.

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

Radial head fracture (red arrow) with posterior and anterior sail signs (blue arrows)

Anterior and posterior fat pad signs (in a case of an undisplaced fracture of the radius head, which is not visible directly).

• Ensure there is no tenderness over the rest of the forearm/wrist, to rule out an Essex-Lopresti fracture
• Typically diagnosed on elbow X-ray (fractures are often subtle)
  • Look for abnormal fat pad
  • Look for radiocapitellar line disruption

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome
• Ice, elevation

Modified Mason Type

Managment is often based on the Modified Mason classifications

• Type I - Nondisplaced or minimally displaced (<2mm) with supination and pronation intact or only limited by pain but not due to fracture
  • Immobilization with posterior long arm splint and sling in flexion and non-operative
• Type II - Displaced >2mm or angulated, possible mechanical limitation to forearm rotation due to the fracture fragment
  • Immobilization with posterior long arm splint and sling in flexion and operative follow-up for ORIF
• Type III - Comminuted and displaced causing mechanical disruption to rotational motion
  • Immobilization with posterior long arm splint and sling in flexion and operative follow-up for ORIF
• Type IV -Radial head fracture with associated elbow dislocation
  • Urgent coordination for ORIF or radial head arthroplasty due to need for annular ligamentous repair

Immobilization

• Sling immobilization in flexion
• Nondisplaced fracture with no mobility restrictions: ortho follow up within 1wk
• Displaced fracture or mobility restrictions: ortho follow up within 24hr

Disposition

• Normally outpatient

See Also

• Elbow diagnoses
• Elbow Fracture (Main)
• Radial head fracture (peds)
• Essex-Lopresti fracture