Radial head fracture
|Radial head fracture|
|Radial head fracture (red arrow) with posterior and anterior sail sign (blue arrows)|
|Symptoms||Pain and swelling of the elbow|
|Usual onset||20s to 60s yr old|
|Types||Type I, II, III, IV|
|Causes||Fall on an outstretched arm|
|Treatment||Arm sling or splint followed by mobilization, surgery|
|Frequency||Relatively common (1 in 2,500 people a year)|
Radial head fractures are a type of elbow fracture that typically occurs after a fall on an outstretched arm. Symptoms generally include pain and swelling around the elbow. There may also be difficulty moving the elbow or forearm. About 30% of people have additional injuries. Complications may include decreased ability to move the elbow.
Most occur as a result of a fall onto a unbend or minimally bend elbow; though they may also occur due to a direct hit. Diagnosis is generally based on X-rays, though the only indication may be a joint effusion. They may be divided into four main types by the Mason classification.
Treatment is based on the fracture type. If the fracture is well aligned an arm sling for a few days followed by a gradual return to using it normally may be all that is required. If the fracture is misaligned < 2 mm, an arm sling may be worn for a couple of weeks followed by physiotherapy. For fractures with greater misalignment, surgery to place screws or remove peices of bone may be required. For extensive fractures, the radial head may require replacement. After surgery it can take 3 months to return to normal activity.
Radial head fractures are relatively common, occurring in about 1 in 2,500 people a year. They represent about a third of elbow fractures. They most commonly occur in a person's 20s to 60s. Women are more commonly affected than men. The first in-depth classification of radial head fractures was in 1954 by Mark L. Mason.
Signs and symptoms
Radial head fractures are diagnosed from an assessment and diagnostic imaging. Assessment may include pain or tenderness at the radial head, bruising, swelling, and a limited range of motion of the elbow. Diagnostic imaging may include ultrasound, plain X-ray, CT scan, and magnetic resonance imaging (MRI). A fat pad sign may be present on diagnostic imaging and may indicate a radial head fracture.
|4||Radial head fracture with dislocation of the elbow|
Radial head fracture treatment is informed by the Mason-Johnston classification, patient symptoms, and fracture stability. An unstable fracture will involve fracture displacement, fractures to adjacent structures and injury to other associated soft tissues. A stable type 1 radial head fracture is typically managed with conservative measures including joint aspiration, immobilization in a sling for a few days and followed by early range of motion exercises. If range of motion is still limited after joint aspiration it may indicate a mechanical block which is treated surgically. Stable type 2 radial head fractures may be treated as a type 1 if the displacement is minimal. Unstable type 2 - 4 fractures generally warrant surgery. Surgical correction can include fracture fragment excision, radial head reconstruction, open reduction and internal fixation, and radial head excision with artificial replacement. Associated structures that were damaged during the injury may also need to be repaired.
Rehabilitation exercises are recommended and tailored to fracture and treatment type. It is recommended to wait 6 weeks before resuming load bearing with a stable type 1 fracture and 10-12 weeks following surgery for unstable type 2-4 fractures.
Stable type 1 and 2 radial head fractures often have good outcomes with most cases regaining complete range of motion and having minimal residual stiffness or pain. Outcomes for unstable type 2-4 radial head fractures vary greatly depending on the severity of the injury and the surgical intervention.
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