With a radial head fracture of the elbow, the longer you delay treatment, the higher your chance of complications and permanent damage. From chronic pain to loss of range of motion, from degenerative joint disease (osteoarthritis) to nerve damage, a radial head fracture of the elbow can severely impact your life, preventing you from doing everyday activities. But it needn’t be that way. Not if you make it a point to see the highly capable and accomplished orthopedic specialists at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado. Foremost in their field, they’ll quickly become foremost in your life. You can count on it.

OVERVIEW

While trying to break a fall with the hands may seem instinctive, the force from the fall travels through the wrist, forearm, and into the elbow, where it could break the smaller bone (radius) in the forearm. Fractures of the radius often occur in the part of the bone near the elbow, called the radial “head.” These injuries are often referred to as FOOSH injuries, FOOSH being an acronym for “fall on an outstretched hand”. Radial head fractures are the most common type of fracture in the elbow occurring in about 20-30 % of all acute elbow injuries. They are more frequent in women than in men and are more likely to happen in people who are between 30 and 40 years of age.

ABOUT THE ELBOW

The elbow serves two distinct functions: 1) to bend and straighten and 2) to turn the palm up and palm down. The elbow utilizes three bones in articulation to accomplish these purposes—the humerus, ulna, and radius. The radial head is shaped like a disk and is key to many arm movements. The bones of the elbow are held together by a joint capsule, tendons, and a collection of ligaments that support the elbow and keep it from flopping around. A ligament is a piece of connective tissue that connects bones. Many muscles are connected to the bones around the elbow joint, but the thicker portions of the muscle don’t cover the actual elbow. So, the elbow isn’t well protected and is at risk for injuries like radial head fractures.

WHAT IS RADIAL HEAD FRACTURE?

In a FOOSH injury, the forearm is turned inward. This causes sudden, massive force onto the elbow joint through the hand and the extended arm. In the process, the radial head collides with the solid end of the humerus and breaks. About every third of the patients with a radial head fracture will also have injuries to the ligaments or bone structure. The most common injury is to the lateral collateral ligament, which supports the elbow joint capsule. Other collateral ligaments, the annular ligament, and the joint capsule may be injured. The solid fibrous capsule connecting the ulna and radius along the entire length may also be torn. The carpal bones may also break during the fall. Radial head fractures are classified using the Mason classification, which groups fractures based on the amount of displacement and comminution. There are 4 classifications of radial head fractures:

• Type I: small non-displaced cracks where bones remain fitted together. (chisel fracture)
• Type II: partial articular fractures with displacement
• Type III: comminuted fractures involving the entire radial head
• Type IV: fracture of the radial head with dislocation of the elbow joint

CAUSES

The most common cause of a radius head fracture is breaking a fall with an outstretched arm. Radial head fractures can also occur due to a direct impact on the elbow, a twisting injury, sprain, dislocation, or strain. A radial head fracture can happen simply from a trip or fall at work. Other than FOOSH injuries, repetitive pressure on the elbow, awkward landings, and high-impact collisions can result in trauma to the elbow. That is why radial fractures of the elbow are quite common in sports such as cycling, skateboarding, snowboarding and skiing, football, basketball, gymnastics, martial arts, and wrestling

SYMPTOMS

Symptoms of radial head fractures of the elbow include:

• Pain on the outside of the elbow
• Swelling in the elbow joint
• Difficulty in bending or straightening the elbow accompanied by pain
• Inability or difficulty in turning the forearm (palm up to palm down or vice versa)
• Difficulty turning the forearm 
• Bruising 
• Tenderness in the injured area 
• Paleness or numbness in the forearm, hands, and fingers

NON-SURGICAL TREATMENTS

Most radial head fractures are treated without surgery. Conservative treatments include:

• Over-the-counter non-steroidal anti-inflammatory drugs like (NSAIDs) aspirin, ibuprofen  and Naproxen for immediate relief
• Prescription painkillers only if the pain is intolerable
• Application of ice packs during the first 24-48 hours of injury may reduce pain and swelling
• The injured arms should be rested by keeping them elevated
• Use of a splint or sling may be recommended for a stipulated time
• Avoid moving the injured elbow joint and give it adequate rest, keeping it elevated
• Joint aspiration- use of a syringe to drain out excess fluids if they accumulate in or near the joint

WHEN IS SURGERY INDICATED?

Displaced fractures typically require operative management. The goal of operative treatment is to align the fracture and the cartilage surfaces. The cartilage surfaces are the gliding mechanism by which the elbow moves. Typically, better alignment is associated with better function. Three procedures that may be options include:

Operative fixation: this is the preferred treatment method in selected displaced fractures of the radial head where rotational movements are impeded. It consists of realigning the fragments of bone to restore the shape of the bone and then fixing the fragments with metal devices such as screws with or without a plate; the metal devices hold the position of the fragments until the fracture has healed.

Radial head replacement: severely fragmented radial head fractures may not be amenable to repair. These fractures may be treated with radial head replacement.

Radial head excision: severely fragmented fractures of the radial head that are not associated with a ligament injury may be treated by surgical removal of the bone fragments. This treatment may be considered for individuals with limited demands on the elbow.

GETTING THE RIGHT DIAGNOSIS.  GETTING THE RIGHT DOCTOR.

Due to the varying elements and stages of radial head fractures of the elbow, you need first-class and exacting diagnosticians to assess and treat the injury correctly. At OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado, their many years of experience in treating these injuries ensure treatment specific to your needs. In the process, we consider the patient’s specific needs for arm function as well as the underlying injury pattern, including any associated injuries. After a thorough examination of the arm, wrist, and fingers, checking for deformities, loss of function, or nerve sensation, X-rays may be required to assess the severity and exact location of damage. MRI scans may be recommended if the doctor suspects soft tissue or ligament injury. Radial head fracture is not just a bone injury. There often are associated injuries, which must be considered during the initial diagnosis and further treatment. At Advanced Orthopedic, their experts offer compassionate leading-edge care so that you can focus on getting back to life as usual.