At the elbow, the radius articulates with the humerus and proximal ulna. These articulations allow flexion-extension of the elbow and pronation-supination of the forearm (rotating the forearm for things like holding your hand out to collect change).  The radial head is the end of the radius bone at the location of the elbow.   Radial head and neck fractures are common and account for one third of all fractures of the elbow and approximately 1.5%-4% of all fractures in adults (Kova, et al 2013).  How do they happen?

radialh

Radial head fractures most commonly result from a fall onto the outstretched hand with the elbow slightly flexed and the forearm in a pronated position (palm facing down).  The force of the impact will lead to the radial head coming into contact with the humerus, causing the head of the radius to fracture.  The fracture may also occur from direct trauma or as a component of high-energy trauma. For example, fending off an opponent during sport.

 fallonhand

People who have fractured their radial head will have pain over the lateral aspect (side of the elbow away from the body) of the elbow and potentially restricted motion and swelling. Radial head fractures have been classified into four types. Type I and type II fractures, which are minimally displaced, can be managed conservatively, with a short period of immobilization in a splint, followed by an exercise program.

 radialhead

Type II fractures, which have a displaced fragment that is limiting movement, will require surgery. This includes excision of small bone fragments or open reduction internal fixations for larger displaced bone fragments.

Types III and IV require surgery. This can include the use of internal fixators, such as plates and screws, or removal of the radial head if the bone is comminuted. Post surgery a short period of immobilization and an exercise program is implemented to encourage the return of movement.

Associated soft tissue injuries can occur to the elbow when the radial head is fractured. The ligaments, which provide support to the elbow, are frequently injured in type III and IV fractures. Depending on the severity of these soft tissue injuries they can also repaired with surgery.

Can you recover ok?

Outcomes vary depending on the severity of the fracture and management. The elbow is prone to stiffening due to its complex soft tissue anatomy that can tighten quickly post injury. Swelling, scarring, pain and prolonged immobilisation can all lead to restricted movement of the elbow and forearm.  Here at Riverina Hand Therapy, we work with patients to regain full movement and strength. Patients are prescribed home exercise programs so they can work on their movement in between therapy sessions.   

The sooner elbow range of motion exercises can be commenced post injury the less chance the elbow has of stiffening and affecting function in the long term.

References:

Dotzis, A, Cochu, G, Charissoux, J, Arnaud, J, 2006, Comminuted fractures of the radial head treated by the Judet floating head prosthesis, The Bone & Joint Journal

Kovar M, Jaindl M, Thalhammer G, Rupert S, Platzer P, Endler G, Vielgut I, Kutscha-Lissberg F, 2013, Incidence and analysis of radial head and neck fractures. World J Orthop, Apr 18.