5 Things You Need to Know About Radial Head Fractures

1. Typically Happens With a Fall
People instinctively reach our their hands to break a fall. The force could travel up the wrist and up the forearm bones and then compress the elbow joint, causing a fracture of the upper portion of the radius--the "radial head." It could also dislocate the elbow and chip off a piece of the radial head on its way out of socket.
2. Pain and Swelling
Some early symptoms are your typical ones for a fracture--pain and swelling at the fracture site. In this case, it would be the outer (lateral) portion of the elbow joint. There may be difficulty or even complete inability to rotate the forearm. Attempts at motion may be met with pain or a grinding sensation.
3. Minor Fractures May Be Treated Without Surgery
If the fracture is relatively nondisplaced, and it does not impede functional range of motion (100-degree arc in flexion/extension and rotation), it may heal without surgery. Typically, the elbow is kept in a sling for 7 to 10 days to allow the swelling and pain to subside. Then early motion exercises are started, usually with the aid of a therapist. Even with early motion, it may be difficult to get your elbow fully straight.
4. Other Fractures Will Likely Need Surgery
If the pieces are of decent size, screws and/or plates may be used to stabilize the fracture fragments. This is quite difficult. The radial head is shaped like a saucer, but a very small one. The diameter is only slightly longer than 2 cm. The screws and plates must be very small. They also must not penetrate the joint, and they must not affect forearm rotation.
5. Removal or Prosthetic Replacement
In older patients, whose bones are more brittle, radial head fractures can be severely comminuted, or smashed to bits. In these cases, the pieces can be smaller than the screws doctors use to fix them! Obviously, this won't work. Sometimes it is better to remove the entire radial head to prevent the pieces from grinding up the elbow. However, removing the radial head may destabilize the elbow or forearm. This is especially a concern in Essex-Lopresti injuries. This occurs when the force of the injury disrupts the interosseus ligament connecting the two forearm bones. Removing the radial head will cause proximal migration of the radius. As the radius is pushed closer to the elbow, the forces across the wrist are altered, placing more force on the other bone, the ulna. In these cases, it may be advantageous to replace the radial head with a prosthesis. It prevents proximal migration of the radius and also protects the medial ligaments of the elbow if they are injured.