CT Scan of a broken radial head (fractured radial head)
What is a radial head fracture of the elbow?
Your elbow is made up of 3 bones.
They are the:
- Humerus (the upper arm bone).
- Ulna (the larger forearm bone on the little finger side). The end of the ulna is the tip of your elbow.
- Radius (the smaller forearm bone on the thumb side). The end of the radius that is part of the elbow is called the radial head.
A fracture is a break in a bone.
A radial head fracture can occur from a fall on an outstretched arm or a direct blow to the elbow.
It can occur allow or be part of a more severe injury to the elbow such as an Elbow fracture dislocation.
Symptoms
- Pain on the outside of the elbow
- Swelling in the elbow joint
- Difficulty in bending or straightening the elbow accompanied by pain
- Inability or difficulty in turning the forearm (palm up to palm down or vice versa)
Causes
Radial head fractures are common injuries, occurring in about 20 percent of all acute elbow injuries. They are more frequent in women than in men and occur most often between 30 and 40 years of age. Approximately 10 percent of all elbow dislocations involve a fracture of the radial head. As the upper arm bone (humerus) and the ulna return to their normal alignment, a piece of the radial head bone could be chipped off (fractured).
How does it occur?
A radial head fracture usually occurs from a fall on an outstretched arm. It can also occur from a direct blow to the elbow.
Risk Factors
There are no specific risk factors for fractures of the radial head.
Investigations
How is it diagnosed?
Your healthcare provider will examine your elbow to check where it is tender. You will have an X-ray taken. Sometimes a small break in the radius does not show up on the first X-ray, so a CT scan may be required.
Xray
CT Scan
CT Scan with 3D reconstruction of a fracture of the radial head
CT Scan of a fracture of the radial head
Complications
Damage to nerves – this is an uncommon problem. Symptoms include tingling, numbness or weakness.
Damage to blood vessels – this is also an uncommon problem.
Compartment syndrome – this is when internal bleeding inside the forearm resulting in increased pressure within the forearm. If not treated with surgery immediately it can cause permanent damage to nerves supplying the wrist and hand.
Infection – this may be a problem if the fracture has broken through the skin, or if the fracture is treated with an operation
Malunion – this is when the bone heals in an abnormal way, such that the normal structure of the bone is disrupted. This may result in an abnormal angle of the bone within the arm.
Nonunion – this is when the ends of the fracture fail to knit together at all. The result is that the bone remains in two pieces.
Persistent pain
Elbow stiffness
Synostosis – this is when bone grows between the two bones within the forearm (radius and ulna). It can cause pain and limit to movement.
Treatment
Radial head fractures are classified according to the degree of displacement (movement from the normal position).
Type I Fractures
Type I fractures are generally small, like cracks, and the bone pieces remain fitted together.
The fracture may not be visible on initial X-rays, but can usually be seen if the X-ray is taken three weeks after the injury.
Nonsurgical treatment involves using a splint or sling for a few days, followed by early motion.
If too much motion is attempted too quickly, the bones may shift and become displaced.
Type II Fractures
Type II fractures are slightly displaced and involve a larger piece of bone.
If displacement is minimal, splinting for one to two weeks, followed by range of motion exercises, is usually successful.
Small fragments may be surgically removed.
If the fragment is large and can be fitted back to the bone, the orthopaedic surgeon will first attempt to fix it with pins or screws. If this is not possible, however, the surgeon will remove the broken pieces or the radial head.
For older, less active individuals, the surgeon may simply remove the broken piece, or perhaps the entire radial head.
The surgeon will also correct any other soft-tissue injury, such as a torn ligament.
Type III Fractures
Type III fractures have multiple broken pieces of bone, which cannot be fitted back together for healing.
Usually, there is also significant damage to the joint and ligaments.
Surgery is always required to remove the broken bits of bone, including the radial head, and repair the soft-tissue damage.
Early movement to stretch and bend the elbow is necessary to avoid stiffness.
A prosthesis (artificial radial head) can be used to prevent deformity if elbow instability is severe. Even the simplest of fractures will probably result in some loss of extension in the elbow. Regardless of the type of fracture or the treatment used, physiotherapy will be needed before resuming full activities.
How is it treated?
A type 1 (straight) radial head fracture may be treated with a sling or a splint for a few days until there is no pain. You can then begin doing the rehabilitation exercises given to you by your provider. If you have a large type 1 fracture or a type 2 or 3 fracture, you will have to keep your arm from moving for a longer time. You may need to have your arm in a cast, splint, or sling. Sometimes surgery is needed. In some cases, even after the fracture heals, your elbow may feel stiff and you may not be able to fully straighten your elbow. Exercises will help you gain back as much range of motion and strength as possible. Your provider will tell you when you can begin elbow exercises.
How long will the effects last?
A radial head fracture usually heals in 3 to 6 weeks.
When can I return to my normal activities?
Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your elbow recovers, not by how many days or weeks it has been since your injury has occurred. The goal is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury. You may return to your activities
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
There is not much to do to prevent fractures of the radial head.