Radial head fractures have a misleading name — it’s a common elbow injury, not a head injury. The elbow isn’t something people think about all the time, but its function allows you to bend and straighten your arms and is also involved in the motion of turning the hand over so the palm faces up or down. A radial head fracture is not just a bone injury. There often are associated injuries, which must be taken into account during the initial diagnosis and further treatment. Delayed treatment or less-than-ideal treatment of a radial head fracture bears the risk of late complications, which will greatly impact the patient’s daily living and quality of life. That’s why you need to see the best orthopedic specialists like those at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado.

OVERVIEW

Radial head fractures are common injuries occurring in about 20% of acute elbow injuries and also in many elbow dislocations. They are most common in women and people between the ages of 30 and 40. About every third patient with a radial head fracture will also have injuries to the ligaments, especially to the lateral collateral ligament which supports the joint capsule. Other ligaments and the joint capsule itself may be injured. The solid fibrous capsule connecting the ulna (the longer of the two bones in the forearm) and radius along the entire length of the bone can be torn. Even the carpal bones may break.

ABOUT THE ELBOW

The elbow is the joint between the upper arm and the forearm. The radial head is shaped like a disc and allows one to move the forearms in a palms-up to a palms-down position and straighten the arm and elbow out in space wherever needed. The elbow joint is surrounded by a thick capsule. There are lots of ligaments (tissues that connect bone to bone) that make the elbow stable and not “floppy.” Many muscles are attached to the bone on both sides of the elbow joint, but the thickest parts of the muscles aren’t at the elbow itself. That’s why when touching the elbow one can feel the bones easily under the skin. That also means it can be easy to break the elbow because there isn’t much padding. There are also nerves and blood vessels that cross the elbow. These are located mostly in the front of the elbow and on the inside. The ulnar nerve is located on the inside of the elbow close to the bone. When you hit this nerve, it is very painful and is commonly called hitting the “funny bone.”

WHAT IS RADIAL HEAD FRACTURE?

There are a few systems used to classify radial head fractures, but the original system used to differentiate between the injuries is called the Mason classification. It outlines three different fractures that are grouped by the degree to which the bones are out of their normal position:

• Type 1 fractures: small cracks in the bone, but the elbow remains in its proper place
• Type 2 fractures: larger cracks in the bone and the bones may be slightly out of alignment with each other
• Type 3 fractures: these are the most serious with the radial head being broken in multiple places and there is damage to the elbow ligaments and tendons
• Type 4 fractures: these mean there has also been an elbow dislocation

CAUSES

The most common cause of a radial head fracture is breaking a fall with an outstretched arm. They can also occur due to a direct impact on the elbow, a vehicle accident, a twisting injury, sprain, dislocation, or strain. Individuals involved in sports such as skateboarding, cycling, lacrosse, hockey, football, or gymnastics are at risk. In the fall, the forearm is turned inward. This causes sudden, massive forces through the hand and extended arm onto the elbow joint in the process. The straighter the elbow joint is during the fall, the more likely a radial head fracture.

SYMPTOMS

• Severe pain in the outer part of the elbow
• Swelling at the elbow joint
• Inability to bend or straighten the elbow due to pain
• Difficulty twisting the forearm to turn the palm up or down
• Bruising
• Stiffness
• Visible deformity indicating dislocation

NON-SURGICAL TREATMENTS

Non-surgical approaches depend on the type and degree of the fracture. For type 1 fractures, it involves using a splint or sling for a few days, followed by an early and gradual increase in elbow and wrist movement (depending on the pain). In type 2, if displacement is minimal, treatment may involve wearing a sling or splint for 1-2 weeks followed by physical therapy and range-of-motion exercises.

WHEN IS SURGERY INDICATED?

Surgery is the best option to prevent long-term loss of function in the elbow. A surgeon may recommend an open reduction and internal fixation (ORIF) procedure where they access the broken bone, mend it, and return it to proper alignment. The term “internal fixation” refers to the way the bone is reconnected sometimes using plates and screws. Depending on how seriously the radial head was fractured, a damaged bone fragment from the arm may need to be removed (fragment excision). In some cases, the radial head itself may need to be removed (radial head excision). These bone fragments can impede proper elbow movement and cause long-term problems. Younger or more physically active patients may prefer having the fractured radial head surgically replaced with a prosthesis (radial head replacement). As with many elbow injuries, there may be damage to other joints, bones, ligaments, tendons, or muscles, so any soft tissue injuries will need to be repaired.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.

Your doctors might recommend an X-ray to confirm the fracture and assess the displacement of the bone. A CT scan can obtain further details of the fracture, especially the joint surface. A radial head fracture should always be treated by an elbow specialist to avoid complications and late complications due to poor diagnosis, treatment, and healing. These complications can be serious including frozen elbow, chronic instability, early joint wear, or the radial head dying off due to blood flow disorders. In the wrong hands, damage due to undetected associated injuries can cause long-term problems. The extensively experienced orthopedic experts at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado are renowned for their excellence in diagnosing and treating radial head fractures with exacting detail, and their advanced surgical techniques ensure the most successful outcomes. If you have any type of elbow injury, the first thing to do is consult with the accomplished and attentive surgeons at Advanced Orthopedics to ensure the mobility that will allow you to live your best life. Schedule an appointment with an elbow specialist today.