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Radial Head Fracture
Aka: Radial Head Fracture, Radial Neck 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
- Symptoms
- Painful and limited Forearm movement
- Signs
- Tenderness over radial head (distal to the lateral epicondyle)
- Local swelling
- Pain on Forearm rotation or elbow flexion
- Imaging
- Elbow XRay
- See Elbow XRay
- Sail Sign (Anterior Fat Pad Sign)
- Posterior Fat Pad
- Special Views
- Radial Head-Capitellum View
- Isolates radial head without overlapping shadows
- 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
- Mason Fracture Type IV
- Fracture with Elbow Dislocation
- Management: Adult
- Non-displaced or minimally displaced Radius Fracture (Mason Type I)
- Conservative Management
- Initial Option 1: Immobilize for 5-7 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
- Relief of severe pain from swelling
- Aspirate Elbow joint at posterolateral triangle
- Displaced or comminuted Radius Fracture (Mason Type II or more)
- Surgical excision of radial head or ORIF (preferred within 24-48 hours)
- 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]