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Radial Head Fracture
Aka: Radial Head Fracture, Radial Neck Fracture
- See Also
- Forearm Fracture
- Epidemiology
- Radial Head Fractures account for >5% of all Fractures and one third of elbow Fractures
- Etiology
- Fall on Outstretched Hand with elbow extended and Forearm pronated
- Direct blow to lateral elbow
- Exam
- See Elbow Exam
- See Forearm Fracture
- Evaluate elbow stability with valgus and varus stress testing (see Elbow Exam)
- Assess for Medial or lateral collateral ligament injury
- Symptoms
- Painful and limited Forearm movement (esp with extension and supination)
- Signs
- Tenderness over radial head (distal to the lateral epicondyle)
- Local swelling
- Pain on Forearm rotation or elbow flexion
- Elbow joint effusion is typically present
- Imaging
- Elbow XRay
- See Elbow XRay
- Sail Sign (Anterior Fat Pad Sign)
- Posterior Fat Pad
- XRays are often normal initially (have a high index of suspicion)
- Special Views
- Radial Head-Capitellum View
- Isolates radial head without overlapping shadows
- Diagram

- Complications
- Lateral Elbow Instability
- Medial or lateral collateral ligament injury in >50% of Fractures (esp. if displaced)
- Evaluation: Mason Classification
- Mason Fracture Type I
- Nondisplaced Fracture without mechanical obstruction
- Mason Fracture Type II
- Fracture wirth displacement >2 mm or angulation >30 degrees
- Mason Fracture Type III
- Comminuted Fracture of entire radial head
- Mason Fracture Type IV
- Fracture with Elbow Dislocation
- Indications: Orthopedic Referral
- Mason Type 2-4
- Abnormal varus or valgus testing
- Suggests medial or lateral collateral ligament injury
- Management: Adult
- Displaced or comminuted Radius Fracture (Mason Type II or more)
- Surgical excision of radial head or ORIF (preferred within 24-48 hours)
- Non-displaced or minimally displaced Radius Fracture (Mason Type I)
- Conservative Management
- Initial Option 1: Immobilize for 3-7 days with elbow at 90 degrees
- Light posterior splint or
- Sling with comfort
- Initial Option 2: Immediate mobilization
- Associated with decreased pain and better initial function
- Similar healing rates to option 1
- Continue Sling for 1-2 weeks after splint removed
- Exercises
- Early elbow range of motion Exercises and later strengthening Exercises
- Home programs for elbow rehabilitation appear to be as effective as physical therapy
- Egol (2018) J Bone Joint Surg Am 100(8): 648-55 +PMID:29664851 [PubMed]
- Relief of severe pain from swelling
- May aspirate Elbow joint at posterolateral triangle, but lack of evidence for benefit
- Foocharoen (2014) Cochrane Database Syst Rev (11): CD009949 [PubMed]
- Follow-up at 3-4 weeks
- Repeat Elbow XRay
- Expect return to full use at 3-4 weeks
- Indications for extended restrictions for additional 2-3 weeks
- Medial or lateral collateral ligamentous instability
- Less than full range of motion
- Decreased strength
- XRay with incomplete healing
- Management: Child
- Non-displaced Fracture and <15-30 degrees angulation
- Management as for non-displaced Fracture in adults
- Displaced Fracture >50% or >15-30 degrees angulation (60 degrees may be acceptable in some cases)
- Reduction
- Closed
- Open reduction and internal fixation (ORIF)
- Radial head is never excised in growing child
- Epiphysis removal results in unequal Forearm growth
- Prognosis
- Non-displaced Fracture or effective early reduction
- Expect some loss of elbow extension
- Minimal or no functional Impairment expected
- Delayed effective management of displaced Fracture
- Permanently restricted elbow Range of Motion
- Traumatic Arthritis
- Fracture fragments act as nidus for calcification
- Myositis Ossificans ensues in anterior elbow region
- References
- Black (2009) Am Fam Physician 80(10): 1096-102 [PubMed]
- Liow (2002) Injury 33(9): 801-6 [PubMed]
- Patel (2021) Am Fam Physician 103(6): 345-54 [PubMed]