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Radial Head Fracture

A radial head fracture is one of the most common injuries around the elbow joint, often resulting from a fall on an outstretched hand or direct trauma to the elbow. The radial head is the top portion of the radius bone, located just below the elbow joint, which articulates with the capitellum of the humerus. It plays a crucial role in both elbow movement and forearm rotation. Any disruption in this area can significantly affect the function of the upper limb, leading to pain, restricted motion, and disability if not treated properly.

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Anatomy and Importance of the Radial Head

The radius is one of the two long bones in the forearm, the other being the ulna. At its upper end, the radius widens to form the radial head, which is disc-shaped and covered with cartilage. The radial head articulates with:

  • The capitellum of the humerus (forming part of the elbow joint).
  • The radial notch of the ulna (forming the proximal radioulnar joint, which allows rotation).

Because of its critical role, fractures in this region can severely impair daily activities such as writing, lifting, turning a doorknob, or even personal care tasks.

Causes of Radial Head Fracture

Most radial head fractures occur due to indirect trauma. The common mechanisms include:

1. Fall on an Outstretched Hand (FOOSH)

  • When a person falls and instinctively stretches the hand forward, the impact force travels up the forearm to the elbow, causing the radial head to strike against the capitellum and fracture.

2. Direct Trauma

  • A direct blow to the lateral aspect of the elbow, although less common, can fracture the radial head.

3. Sports Injuries and Accidents

  • High-impact sports such as football, basketball, or cycling, as well as motor vehicle accidents, frequently contribute.

Classification of Radial Head Fractures

Several classification systems exist, but the most widely used is the Mason Classification, which divides fractures into types based on severity and displacement:

  • Type I: Non-displaced or minimally displaced fractures (less than 2 mm). These are stable fractures that often heal with conservative treatment.
  • Type II: Displaced fractures with more than 2 mm displacement or angulation, possibly affecting motion.
  • Type III: Comminuted fractures (bone broken into several pieces), often unstable and requiring surgical intervention.
  • Type IV: Radial head fractures associated with elbow dislocation.

Signs and Symptoms

Patients with a radial head fracture typically present with:

  • Pain over the lateral aspect of the elbow, worsened by movement.
  • Swelling and tenderness around the joint.
  • Difficulty in using the arm for basic tasks.
  • Sometimes bruising and visible deformity in severe cases.
  • A common clinical sign is pain when the patient tries to rotate the forearm or when the examiner compresses the radius against the capitellum.

Diagnosis

Diagnosis involves both clinical assessment and imaging techniques:

1. History and Physical Examination

  • Mechanism of injury, pain location, swelling, and range of motion are evaluated.
  • Examination of the entire upper limb is necessary to rule out associated injuries.

2. Imaging Studies

  • X-rays: Standard anteroposterior and lateral views are taken. An oblique view may help identify subtle fractures.
  • CT scan: Provides detailed images for complex or comminuted fractures.
  • MRI: Rarely used but may be indicated for associated soft tissue injuries, like ligament tears.

Treatment

Treatment depends on the type of fracture, displacement, and functional demands of the patient.

1. Non-Surgical Treatment

  • Recommended for Mason Type I and some Type II fractures without mechanical block to motion.
  • Immobilization with a sling or splint for a short period (usually 1–2 weeks).
  • Early mobilization exercises to prevent stiffness.
  • Pain management with analgesics and anti-inflammatory drugs.
  • Patients are encouraged to begin gentle range-of-motion exercises as soon as pain allows, to minimize complications.

2. Surgical Treatment

  • Required for displaced Type II fractures with movement block, Type III, and Type IV fractures.
  • Open Reduction and Internal Fixation (ORIF): Metal plates, screws, or wires are used to realign and stabilize the bone.
  • Radial Head Excision: Removal of the fractured radial head, generally avoided in young and active individuals because it may compromise stability.
  • Radial Head Arthroplasty: Replacement with a prosthesis, used for severely comminuted fractures or when fixation is not feasible.

Rehabilitation

Rehabilitation is crucial for functional recovery after both conservative and surgical treatment.

  • Early Motion: Gentle exercises to restore flexion, extension, pronation, and supination.
  • Strengthening Exercises: Gradually introduced once pain and swelling subside.
  • Physiotherapy: May include modalities such as ultrasound, heat, and manual therapy to improve circulation and reduce stiffness.
  • Return to Activities: Light activities may resume in a few weeks, but strenuous tasks and sports may take months.

Conclusion

A Radial Head Fracture is a common but potentially disabling injury that affects the elbow joint and forearm function. Understanding the anatomy, mechanism of injury, and classification is crucial for proper diagnosis and management. Treatment may range from simple immobilization and early motion in mild cases to complex surgical reconstruction in severe injuries. Rehabilitation plays a vital role in regaining full function and preventing complications. With timely and appropriate care, most patients achieve a good outcome and return to their daily activities without significant limitations.

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