Radial Head Fracture
Description/Cause
Prevalence/Risk Factors
Signs/Symptoms
Objective/Special Tests
Treatment/Interventions
1. Kodde I, Kaas L, Van Es N, Mulder P, Dijk N, Eygendaal D. The effect of trauma and patient related factors on radial head fractures and associated injuries in 440 patients. BMC Musculoskeletal Disorders. 2015; 16:135
2. Yoon A, Athwal G, Faber K, King G. Radial Head Fractures. J Hand Surg. 2012;37A:2626–2634.
- Mason classifications
- Type 1: marginal or fissure fractures without displacement
- Type 2: marginal sector fractures with displacement
- Type 3: comminuted fractures involving the whole head
- Type 4: any fracture of the radial head associated with an elbow dislocation and does not quantify the injury sustained by the radial head itself
- Causes
- Impact along the radius
- Falling on an outstretched arm
- Falling with the hand in pronation with elbow in slight flexion
Prevalence/Risk Factors
- The most common fractures around the elbow
- Estimated incidence of 28-9 per 100,000 per year
- Frequently associated with ligamentous, cartilaginous, or other bony injuries
- An increased risk with the presence of osteoporosis, especially in women over 50 years old
Signs/Symptoms
- Tenderness to the medial and lateral epicondyle regions
- Difficulty moving the elbow joint
- Swelling
- Pain in the wrist and forearm
Objective/Special Tests
- Radiographs
- Usually show an enlarged posterior fat pad if fracture is present
- Taken in the orthogonal plane
- Depending on history and physical examination findings, the shoulder, forearm, and wrist may require imaging to consider any associated injuries
- CT (Computerized Topography) scan
- More accurately defines the fracture
- Can aid in the assessment of how to repair the fracture
- Screens for other osseous or ligamentous injuries
- Palpation
- MMT
- Stability testing
- Range of motion: determine whether or not the patient has full rotation of the forearm using pronation and supination
- If limited rotation: must distinguish between pain and a mechanical block
- Always examine the wrist for associated injury
Treatment/Interventions
- Nondisplaced and minimally displaced fractures can be treated non-surgically
- Displaced fractures are treated non-surgically or surgically
- Dependent on the extend of the displacement and the size of the fragments
- With reasonable alignment, immobilization may be enough
- Surgical treatments
- Dependent of the size and type of fracture
- Non-surgical treatments
- Collar and cuff sling can be used for comfort within the first week and is preferred to cast immobilization
- Hemarthrosis aspiration provides pain relief by decreasing intra-articular pressure
- Early motion of the elbow should begin within the first week if non-surgically treated for decreased in pain, increased range of motion, and improved elbow function
- Rehabilitation
- Dependent on associated ligamentous, cartilaginous, and other bony injuries
- Isometric muscle contractions for the return of muscle tone, which enhances elbow stability
- Radiographs should be used to determine when bony union is sufficient
- Once bony union is confirmed, PROM and strengthening can begin
- Patients treated non-surgically
- AROM
- Must begin early (within 1 week of injury)
- Shown to reduce pain
- Patients treated surgically
- AROM
- Must begin early
- Remain within a safe flexion ROM to prevent elbow subluxation
- If injury to collateral ligaments: permitted rotation should initially be performed with elbow flexed past 90 degrees
- If injury to lateral collateral ligament: elbow extension with elbow in supination should be avoided
- If injury to medial collateral ligament: elbow extension with elbow in pronation should be avoided
- If injury to lateral and medial collateral ligaments: elbow extension should be done in neutral
1. Kodde I, Kaas L, Van Es N, Mulder P, Dijk N, Eygendaal D. The effect of trauma and patient related factors on radial head fractures and associated injuries in 440 patients. BMC Musculoskeletal Disorders. 2015; 16:135
2. Yoon A, Athwal G, Faber K, King G. Radial Head Fractures. J Hand Surg. 2012;37A:2626–2634.
Acknowledgements:
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015
David Funk, Student Physical Therapist at A.T. Still University
Ethan Hunke, Student Physical Therapist at A.T. Still University
Morgan Johnson, Student Physical Therapist at A.T. Still University
Ed Nheiu, Student Physical Therapist at A.T. Still University
Lindsay Walczak, Student Physical Therapist at A.T. Still University
Last edited: July 13, 2015