Radial head fractures may commonly be treated by 1 open reduction and internal fixation orif, 2 radial head excision, or 3 radial head replacement. In order to maintain stability of the injured elbow, the main goal in the treatment of radial head fractures is to restore the anatomy of the radial head and surrounding tissues. Current recommendations for the treatment of radial head fractures. Radial head and neck fractures are common and are present in about 30 percent of all elbow fractures. Depending on the fracture type the treatment is either conservative or surgical. There is no benefit of casting in the initial treatment of mason type i radial head fractures.
The more fragments, and the more displaced the fragments are, the more likely some type of surgery will be required because the fracture fragments get in the way of the motion of the elbow joint. Verify fracture congruity and stability with referring physician andor imaging report. Radial head fractures and dislocations may be isolated just to the radial head and neck and the lateral elbow and proximal forearm, or they may be part of a combined complex fracture injury pattern involving the other structures of the elbow, distal humerus, or forearm and wrist. The mechanism of injury typically involves a fall onto an outstretched hand in a pronated position, which. Radial head fracture usually is not obvious on xray. Providence orthopaedics singapore specialises in the treatment for radial head fracture. Radial head and neck fractures pediatric pediatrics. Radial head arthroplasty modern implants unipolar or bipolar, monoblock or modular, anatomical or nonanatomical, cemented or pressfit correct diameter, height, medial offset and cervicocephalic angle bipolarity permits an automatic positioning of the radial head with respect to the neck and the opposite. If there is no associated elbow instability with lateral ulnar collateral ligament lucl injury, the preferred approach is via a split in the extensor digitorum communis edc origin. Dec 28, 2017 open treatment of radial head fractures begins with the following steps. Case report comminuted radial head fractures treated by the. Nondisplaced fractures can be managed by knowledgeable, primary care physicians. Current concepts in the treatment of radial head fractures in the adult. Regain full painfree rom of elbow and prevent shoulder and wrist stiffness.
Radial head fractures musculoskeletal medicine for medical. It is very important to get your arm moving as soon as possible, to avoid joint stiffness and muscle tightness. The aim of this protocol is to present the method that will be used. The value of elbow arthroscopy in diagnosing and treatment of. Radial head fractures 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. Current concepts in the management of radial head fractures.
This protocol is recommended for masons type i fracture or type ii or iii with orif. A mason type iii radial head fracture, which is characterized by comminuted fragments of the radial head, is a severe injury. Traditional radial head excision is associated with valgus instability and should be. The radial head articulates with the portion of the distal humerus called the capitellum. Radius head fracture an overview sciencedirect topics. Current concepts in the management of radial head fractures ncbi. The injury occurs more commonly in females and in middleaged patients 3. Nov 12, 2019 radial head and neck fractures occur frequently, most often following a fall onto an outstretched hand. Over the last decades, the radial head is increasingly recognized as an important stabilizer of the elbow. The wrist, especially the distal radioulnar joint, may be damaged simultaneously, and the presence of wrist pain, grinding, or swelling should be determined. Patient education radial head fracture the core institute. Bone quality, fragment size, comminution, impaction, and displacement in. If the radial head alignment is off or the fracture is in several pieces, surgical intervention may be advisable. Conservative treatment is advised when the fracture is small or the alignment of the radial head is within normal limits.
In some cases, an artificial radial head may be placed to improve longterm function. Some studies describe a male predominance with a ratio of 2. This type of injury is most commonly caused by a fall onto an outstretched hand. Radial head fractures occur most often in two groups of patients. Radial head fracture commonly occurs with elbow dislocations. A lateral view of a left elbow showing a displaced radial head fracture. Fractures in adults with slight displacement fracture with manipulation. This type of treatment is indicated for radial head fractures type iiiv. Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or.
For treatment of a variety of radial head fractures, the explor radial head system includes both a modular radial head replacement and. A patients guide to adult radial head elbow fractures. This means you can move the joint without causing damage. Know the symptoms, causes, treatment splint, electrotherapy, nsaids.
This includes a hinged brace and activity modifications followed by a formal physical therapy program. Because the radial head played one critical role in the elbow stability, many orthopedic surgeons suggest preserving the radial head during fracture treatment. Multiple classification systems exist to help characterize radial head fractures and their associated injuries, as well as to guide treatment strategies. Blunt or penetrating trauma rarely causes radial head injury. A fracture of the radial head or neck is a break at the elbow end of the radius. An undisplaced fracture does not need manipulation. A patient with radial head fracture dislocations usually presents with a history of a fall on the outstretched hand. Despite appropriate treatment, the outcome may still be unsatisfactory if the patient has residual stiffness and discomfort at the elbow. The radial head plays a critical role in the stability of the elbow joint and its range of motion. Based on the type of radial head fracture, associated complex elbow or longitudinal forearm injuries, select the appropriate treatment option.
Therefore, aim of this study was to assess the significance of elbow arthroscopy in diagnosing and treatment of radial head fractures with associated injuries. Most common fractures of the elbow, approximately 20% of elbow fractures caused by foosh in pronation leading to radial head. Regardless of the type of fracture and treatment used, early exercise to restore movement and strength in the elbow is necessary before resuming full activities. Article information, pdf download for management of radial head fractures. Radial head fractures ace physical therapy and sports. Maximizing outcomes in the treatment of radial head fractures. Control pain and edema protect fracture site minimize deconditioning maintain range in joints around the effected region shoulder, wrist, fingers prevent contractures.
Mason type iii radial head fractures treated by anatomic. Radial head fractures the open orthopaedics journal. Apr 10, 2019 radial head fracture recovery time depends on the severity of the injury and the treatment method your orthopedic surgeon determines best suit your needs. Even the simplest of fractures may result in some loss of movement in the elbow. Many radial head fractures are simple cracks that do not displace and do not require surgery. Advance elbow extension with radial deviation and elbow flexion with ulnar deviation title microsoft word nonoperative treatment of radial head fractures. Jun 20, 2018 radial head fracture usually is not obvious on xray. The value of elbow arthroscopy in diagnosing and treatment. Nonunion of nonoperatively treated fractures of the radial head. Radial head fractures constitute 3% of all fractures 1, 2 and 33% of adult elbow fractures. Physiotherapy department helping your elbow to recover after. Because it is critical to the outcome of all treatment methods, early range of.
Nov 25, 2019 a radial head fracture is the most common type of elbow fracture that occurs in adults. The treatment of radial head fractures remains controversial and difficult. Dec 18, 2015 fracture of the radial head is a common injury. Regardless of the type of fracture or the treatment used. A radial head fracture is the most common type of elbow fracture that occurs in adults. Radial head fractures and all elbow injuries can require extensive physical therapy rehabilitation. When treating radial head fractures, the clinical and radiological assessment allows for an appreciation of fracture characteristics and associated injuries that will influence management plans. The radial head is the name given to the end of the radius that articulates moves against with the distal humerus.
Radial head fractures are common injuries and are accompanied by. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Treatment depends on the degree of angulation and is surgical if angulation remains greater than 30 degrees after closed reduction is attempted. The injury most commonly occurs in young children after sudden tugging of the outstretched and pronated arm e. Orif isolated radial head fractures versus complex radial head fractures other associated fracture dislocation show no significant difference in outcomes at 4 years isolated fractures trended towards better patientrated elbow evaluation score, lower complication rate and lower rate of secondary capsular release. The radial head is part of the radius, one of the two bones of the forearm. The lower end of the arm bone humerus joins with the two bones that form the forearm radius and ulna. Replacement through arthroplasty is the recommended treatment in the context of unstable elbow injury and comminuted radial head fracture. However, additional imaging for bone, such as computerized tomography ct scan may yield additional helpful information. In children closed reduction alone is often successful. These fractures can be treated with a sling and early rmotion after 2472 hours indeed, as soon after injury as discomfort subsides. Radial head fractures are common injuries, occurring in about 20% of all acute elbow injuries.
Early movement to stretch and bend the elbow is necessary to avoid stiffness. Radial head subluxation knowledge for medical students and. Mechanism of injury, symptoms, and signs elbow stability is maintained by. Physiotherapy department helping your elbow to recover. Pdf current concepts in the treatment of radial head. Injuries may occur across a spectrum of severity, ranging from low energy nondisplaced fractures to high energy comminuted fractures. Radial head fracture recovery time depends on the severity of the injury and the treatment method your orthopedic surgeon determines best suit your needs. Your fracture has been assessed as a simple, non displaced fracture which does not require specialist orthopaedic care. Functional outcome after mason iiiii radial head and neck. Control pain and edema protect fracture site minimize deconditioning maintain range in joints around the effected region shoulder, wrist, fingers. The prognosis after this fracture seems to depend more on the severity of the injury, the associated injuries about the elbow, and the type of treatment than on the accuracy of the reduction. Common forearm fractures in adults american family physician.
The best treatment for a radial head fracture depends on a number of factors including the age of the patient, the patients occupation, the findings from examining the elbow, other associated injuries, how the bone has broken and how far the parts of the bone have moved out of position. Maximizing outcomes in the treatment of radial head fractures ncbi. Although fractures of the radial head traditionally are not associated with healing problems, delayed union and nonunion are being seen more frequently after operative and nonoperative treatment. Radial head fracture red arrow with posterior and anterior sail signs blue arrows anterior and posterior fat pad signs in a case of an undisplaced fracture of the radius head, which is not visible directly. Current recommendations for the treatment of radial head. The images generally show the loss of the mild concave curvature of the anterior cortex of the base of the radial head creating an abrupt offset between the radial head and neck 1. In many cases, xrays alone may adequately provide enough information to determine treatment.
In order to maintain stability of the injured elbow, goals of treatment of radial head fractures have become more and more towards restoring. A mason type 1 fracture is a nondisplaced fracture with no mechanical blockage to forearm rotation. Conservative treatment usually coincides with type i radial head fractures. However, optimal treatment of type ii and iii fractures is still the. It seems natural to put out an arm to break the fall, but this often results an elbow injury and possibly a radial head fracture. Radial head fracture can occur in about 20% of all acute elbow injuries. Radial head fracture, radial head replacement, arthroplasty, internal fixation, elbow fracture. Radial head fractures are not treated in a plaster cast, as the fracture is stable. Open reduction internal fixation has shown to have better results. Fashion removable longarm splint holding the elbow in 90 degrees. Questions regarding the progress of any specific patient are encouraged, and should be directed to dr. Monteggia fracture of the proximal ulna with anterior dislocation of the radial head. Similarly the treatment of type iii and iv fractures remain controversial.
Radial head fracture explanation of procedure andor diagnosis anatomy the elbow joint is made up of three bones. Surgical treatment of displaced radial head fractures has evolved from excision of fracture fragments or the entire head of the radius, to several techniques of open reduction and internal fixation orif, and modern types of radial head replacement. Radial head subluxation also pulled elbow or nursemaids elbow refers to the partial dislocation of the head of the radius at the level of the radiohumeral joint. Morrey, in morreys the elbow and its disorders fifth edition, 2018. Begin elbow active rom and activeassisted rom for flexion and extension. Contraindications to excision include a coronoid fracture, mcl deficiency and forearm interosseous ligament injury.
In order to maintain stability of the injured elbow, goals of treatment of radial head fractures have become more and more towards restoring function and stability of the elbow. It is common as it occurs due to a fall on the outstretched hand and present clinically with pain and swelling around the elbow joint. Fractures of the neck of the radius in children clinical. Many elbow dislocations also involve fractures of the radial head. The most common injury seen in adults in the forearm is the radial head fracture. There is no absolute consensus regarding optimal treatment for different fracture types. Over the last decades, the radial head is increasingly recognized as an important stabilizer of the elbow 3, 4. Important factors to consider when making treatment decisions include radial head fracture configuration, associated fractures, elbow and forearm rom, and. Radial head excision still provides a treatment option for these injuries but is typically reserved for low demand and sedentary patients or after failed alternative management. Radial head subluxation knowledge for medical students.
Radial head and neck fractures in children are a relatively common traumatic injury that usually affects the radial neck metaphysis in children 910 years of age. An elbow joint effusion will almost always be present. The radius runs from the wrist to the elbow and the end of the radius at the elbow is a round prominence known as the radial head. Acceptable angulation of 30 o in young children 15 o in older children more than 10 yo corrects with remodelling with growth. Read about related elbow pain causes and its symptoms. Fracture of the radial head accounts for up to one third of all. Treatment depends on the degree of angulation and is surgical if angulation remains greater than 30. Radial head fractures make up approximately 3% of all fractures and they are the most common elbow fracture in adults. Fractures of the neck of the radius in children clinical gate. The mason classification of radial head fractures is useful for determining treatment options. Conditions and treatments minneapolis orthopaedics. Decisionmaking principles a number of parameters must be taken into account when evaluating fractures about the radial head and neck to determine treatment.
Helping your elbow to recover after a radial head fracture pdf, 46kb. Radial head fractures are common elbow injuries in adults and are frequently associated with additional soft tissue and bone injuries. Introduction fractures of the radial head and neck are the most common fractures of the elbow, and account for approximately onethird of all elbow fractures. Specific changes in the program will be made by the physician as appropriate for the individual patient.
482 192 1036 628 1243 847 1119 1222 1377 548 1319 431 1265 747 451 1035 1369 1266 320 880 1238 1353 145 876 697 1200 1312 393 66 771 685 1021 639 400 246 1103 352 1228