Radial Head Fracture Of The Elbow

What Is Your Radial Head?

The radius and the ulna are the two long bones that make up the forearm, traveling all the way from the elbow to your wrist. Specifically the radius is the lateral of the two forearm bones, meaning if standing in the anatomical position where your arms are at your side with the palms facing forward then the radius is the bone that is on the outside furthest from your body (the thumb side) and the ulna is the bone on the little finger side, closest to your body. The “radial head” is the part of the bone that is at the proximal end of the radius bone, being the end closest to the elbow. At the elbow the radius meets the humerus (the long upper arm bone) forming the humeroradial joint, this joint is a pivot joint resembling a ball-and-socket style joint. The swiveling action of the radial head at the elbow through this pivot joint is what is responsible for being able to turn your hand face up and face down (movements  that are anatomically referred to as pronation and supination). A radial head fracture is a break of the radius bone nearest the elbow. Two common fractures near the elbow include a neck of radius just below the “head” of the bone and the radial head itself. The most common cause of these type of fractures is falling with an outstretched arm. When falling in this way, it transfers the force of the impact when breaking the fall with your arm, up the forearm “breaking” the radial head. Given the nature of how they are caused it is easy to see that radial head fractures would be a fairly common injury, for which X-rays will usually be sufficient to identify the injury.

Symptoms Of A Radial Head Fracture

Common symptoms associated with a radial head fracture include:

• Pain and swelling felt at the outside of the elbow
• Difficultly twisting the forearm back and forth (turning the hand through palm up and palm down motions)
• Pain and possible restriction when bending or straightening the elbow

Following a fall on an outstretched arm, the presence of these signs and symptoms would have you suspecting a radial head fracture and indicate a relevance to perform an X-ray to investigate suspicions.

Treatment Of A Radius Injury At The Elbow

Radial head fractures vary in severity according to the degree of displacement. The best management of these injuries is ideally determined by a treating orthopaedic specialist where the injury and therefore relevant treatment approach is gauged according to the type of fracture sustained and individual circumstances.

• Small “cracks” where the bones remain in the right place, or are only minimally displaced can often be treated conservatively. Managed under the guidance of the surgeon and care of a physiotherapist with just a sling and a gradual increase of elbow and wrist movements. Being guided by pain and stage of healing with regard to return to functional activities.
• Other fractures, may varying from those slightly displaced to fractures that are significantly displaced. Some fractures may also involve multiple broken pieces and/or dislocation of the radial head. In these situations a surgeon will operate aiming to fixate any damaged bone they can, remove any small fragments of broken bone that can’t be fixed and repair any soft tissues as relevant. The do this with the intention of restoring mechanical stability and normal anatomical positioning as best as possible. This may be through the use of internal fixation, or even implanting an artificial radial head, if the existing one seems damaged beyond repair.

Following surgery, your surgeon will have guidelines on how the post surgical protocol is to be carried out. This is a balance of protecting the repair, allowing bone healing and soft tissue recovery, whilst encouraging early movement to avoid long term stiffness. Regardless of the type of radial head fracture, physiotherapy to restore movement and strength will generally be prescribed before resuming full activities. The majority of radial head fractures we see do surprisingly well, however sadly sometimes even the simplest of fractures may ultimately result in some loss of movement in the elbow.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance on Radial Head Fractures Of The Elbow should consult his or her general practitioner, sports medicine specialist, physiotherapist or otherwise appropriately skilled practitioner.