Radial Head Fracture

Aka: Radial Head Fracture, Radial Neck Fracture

1. Epidemiology
   1. Radial Head Fractures account for >5% of all Fractures and one third of elbow Fractures
2. Etiology
   1. Fall on Outstretched Hand with elbow extended and Forearm pronated
   2. Direct blow to lateral elbow
3. Symptoms
   1. Painful and limited Forearm movement
4. Signs
   1. Tenderness over radial head (distal to the lateral epicondyle)
   2. Local swelling
   3. Pain on Forearm rotation or elbow flexion
5. Imaging
   1. Elbow XRay
      1. See Elbow XRay
      2. Sail Sign (Anterior Fat Pad Sign)
      3. Posterior Fat Pad
   2. Special Views
      1. Radial Head-Capitellum View
         1. Isolates radial head without overlapping shadows
6. Evaluation: Mason Classification
   1. Mason Fracture Type I
      1. Nondisplaced Fracture without mechanical obstruction
   2. Mason Fracture Type II
      1. Fracture wirth displacement >2 mm or angulation >30 degrees
   3. Mason Fracture Type III
      1. Comminuted Fracture
   4. Mason Fracture Type IV
      1. Fracture with Elbow Dislocation
7. Management: Adult
   1. Non-displaced or minimally displaced Radius Fracture (Mason Type I)
      1. Conservative Management
         1. Initial Option 1: Immobilize for 5-7 days with elbow at 90 degrees
            1. Light posterior splint or
            2. Sling with comfort
         2. Initial Option 2: Immediate mobilization
            1. Associated with decreased pain and better initial function
            2. Similar healing rates to option 1
         3. Continue Sling for 1-2 weeks after splint removed
      2. Exercises
         1. Early elbow range of motion Exercises
      3. Relief of severe pain from swelling
         1. Aspirate Elbow joint at posterolateral triangle
   2. Displaced or comminuted Radius Fracture (Mason Type II or more)
      1. Surgical excision of radial head or ORIF (preferred within 24-48 hours)
8. Management: Child
   1. Non-displaced Fracture and <15-30 degrees angulation
      1. Management as for non-displaced Fracture in adults
   2. Displaced Fracture >50% or >15-30 degrees angulation (60 degrees may be acceptable in some cases)
      1. Reduction
         1. Closed
         2. Open reduction and internal fixation (ORIF)
      2. Radial head is never excised in growing child
         1. Epiphysis removal results in unequal Forearm growth
9. Prognosis
   1. Non-displaced Fracture or effective early reduction
      1. Expect some loss of elbow extension
      2. Minimal or no functional Impairment expected
   2. Delayed effective management of displaced Fracture
      1. Permanently restricted elbow Range of Motion
      2. Traumatic Arthritis
         1. Fracture fragments act as nidus for calcification
         2. Myositis Ossificans ensues in anterior elbow region
10. References
    1. Black (2009) Am Fam Physician 80(10): 1096-102 [PubMed]
    2. Liow (2002) Injury 33(9): 801-6 [PubMed]