What is Radial Head Fractures?
In the past, the radial head, a part of the elbow, was not thought to be very important. Because of this, it was often removed in medical procedures. However, research and long-term studies have shown that this approach can have negative effects. Other injuries that happen at the same time usually influence the treatment approach and how well the patient recovers.
What Causes Radial Head Fractures?
Fractures in the upper part of the radius, one of the bones in your forearm, are usually caused by elbow injuries. These injuries can happen directly, like from a hit to the elbow, or indirectly, like from a fall. Sometimes, these injuries just cause a fracture in the radius. Other times, they might also result in fractures in different areas or damage to the ligaments.
Risk Factors and Frequency for Radial Head Fractures
Radial head fractures, which are a type of elbow fracture, make up about a third of all elbow fractures. They also account for between 1% and 4% of all fractures in adults.
Signs and Symptoms of Radial Head Fractures
When a person injures their elbow directly or falls with their wrist and hand stretched out, they can fracture their elbow. Common symptoms of this injury include pain and difficulty moving the elbow properly. In some cases, there may also be stiffness or inability to move the elbow fully.
Testing for Radial Head Fractures
In cases of non-displaced or incomplete fractures, it’s important to check for areas of pain and small red or purple spots on the skin known as petechiae. Additional injuries may be present, so the inside of the elbow, the flexible tissue connecting the two bones of the forearm, and the base joint of the wrist should be examined, especially in more complex cases. If the fracture’s size and position are unclear, a local anesthetic injection can be used to see if it hinders mechanical movements, indicating a need for surgery.
In complex cases, injuries often involve the ligaments on the outer and inner sides of the elbow and the connective tissue between the bones of the forearm. During surgery, it can be useful to monitor the position of the radius bone as it moves up and down while using an intensifier to visualize the elbow level and wrist joint. Commonly associated fractures affect the head of the radius bone, coronoid process, and olecranon of the elbow joint.
Assessing stability of the elbow, shoulder, and wrist can also provide important information.
Imaging tests like X-rays are helpful for front and side views. If there’s wrist pain, or if the fracture is fragmented, additional X-rays may be ordered for comparison. In complex cases, it may be useful to get a CT scan for better planning.
A popular classification system for these fractures is the Mason system. A Type 1 fracture is a non-displaced fracture. Type 2 involves one displaced bone fragment. Type 3 includes multiple bone fragments. Morrey added a Type 4 for any fracture accompanied by a dislocated elbow, as well as classifications for joint and neck fractures, usually when they encompass roughly 30% of the total and displacements are around 2 mm.
The Hotchkiss system also categorizes these fractures, but primarily based on treatment. Type 1 fractures are non-displaced or slightly displaced (less than 2 mm). Type 2 fractures have parts of the head displaced enough to affect rotation of the forearm and can generally be fixed with surgery. Type 3 fractures are too complex to be repaired with surgery.
Treatment Options for Radial Head Fractures
The goal of treating elbow injuries is to restore a comfortable range of motion, maintain stability in the elbow and forearm, and prevent complications that could arise both immediately and in the long-term, such as arthritis. When deciding on a treatment approach, factors such as the patient’s age, bone quality, functional needs, any additional health concerns, and the specifics of the fracture are taken into account.
Non-Surgical Treatment
Non-surgical approaches are often suited for isolated and less complicated fractures. Non-displaced fractures, those which haven’t shifted out of place, and those with a joint step under 2 mm, a joint surface condition under 30%, and angling under 30 degrees can be managed non-surgically. Even in cases where the fracture is more displaced, if it doesn’t interfere with movement in the joint, a non-surgical approach might be considered.
To confirm that the injury does not obstruct joint movement, a local anesthesia test can be performed. After the diagnosis, the elbow is likely to be immobilized using a plaster or a sling for a couple of weeks; this is followed by a check-up and an x-ray after a week. During this period, it’s beneficial to attempt gentle elbow flexion and extension exercises while the upper arm is rested on a flat surface.
Surgical Treatment
In some cases, surgery may be required. For instance, the radial head (a part of the elbow) may need to be removed in specific cases such as severe pain in older adults who are not highly active and have complex but isolated fractures. Smaller
What else can Radial Head Fractures be?
Simple or incomplete fractures of the elbow can sometimes be confused with other conditions that cause pain on the side of the elbow. Examples of these conditions are tennis elbow, and osteochondritis. It’s important to correctly diagnose these conditions to ensure that patients receive the best possible treatment.
What to expect with Radial Head Fractures
The primary goals for treating fractures in the radial head, a part of the elbow, are to ensure the fracture heals and restore the elbow’s range of motion. The patient’s recovery prognosis is closely tied to associated injuries such as damage to the lateral and medial ligaments, and more complex fractures.
Possible Complications When Diagnosed with Radial Head Fractures
Stiffness after bone-setting surgery or joint replacement surgery can occur. This could be due to the prominent hardware used in the procedure or an oversized prosthesis. Other reasons for stiffness could be tightening of the joint capsule or bone formation.
Further complications may include aseptic necrosis (bone death) and nonunion, which is the failure of a broken bone to heal, sometimes seen after osteosynthesis. However, improperly healed bones are less frequent after osteosynthesis compared to non-surgical treatments.
Arthritis can also occur, as indicated by clinical x-ray studies, although there may not be any related symptoms felt by the patient. Joint instability is less common but it’s crucial to manage injuries appropriately to prevent this issue.
Common complications:
- Stiffness due to prominent surgical hardware or oversized prosthesis
- Stiffness from joint capsule tightening or bone formation
- Aseptic necrosis (bone death) and nonunion after bone-setting failure
- Improperly healed bones, less common following bone-setting
- Arthritis as per x-ray studies, but not always symptomatic
- Joint instability, though less frequent
Preventing Radial Head Fractures
It’s important for patients to adhere to instructions for care and recovery measures after surgery.
