Accompanying Violations

In the case of a fracture of the radial head, various concomitant injuries can occur, depending on the extent of the force involved. Particularly common is parallel damage to the inner collateral ligament of the elbow. Adjacent fractures of the humerus or ulna are also frequently observed.

Of course, the fracture of the radial head can also be associated with other fractures, for example with a fracture of the carpal bone or the part of the radius near the wrist. The ulna and radius are fused together by a connective tissue membrane. This membrane (Membrana interossea) can also tear, especially in comminuted fractures.

Finally, a fracture of the radial head can be accompanied by nerve injuries. The radial and ulnar nerves are particularly at risk, both of which run in the area of the elbow joint. These nerves can be particularly affected by comminuted fractures. However, a complete severing of the nerves with permanent damage is rare.

Diagnosis

The suspicion of a radial head fracture is usually already based on the typical symptoms and the accident mechanism described by the patient. This suspicion can often be substantiated by a physical examination with a pressure pain in the area of the radial head. To confirm the diagnosis, an x-ray image must be taken, on which the fracture can then be seen directly.

It is also important that concomitant injuries are excluded. It is therefore essential to check whether the sensitivity of the hand and forearm has been preserved in order to clarify any concomitant nerve injury. The X-ray image also allows an assessment of whether ulna or humerus are also fractured.If the fracture is not clearly visible on the X-ray image, computed tomography (CT) or magnetic resonance imaging (MRI) can be used for clarification.

Classification

The radial head fracture is often classified according to the so-called AO classification. A distinction is made between three types of fracture: Fractures without joint involvement (so-called extra-articular fractures), fractures in which the joint is also affected but only one of the two forearm bones is broken, and fractures in which the joint is affected and both forearm bones are broken. As an alternative to the general AO classification, radial head fractures can also be classified according to the frequently used Mason classification.

This classification also distinguishes between three fracture types. There are other classifications that can be used to classify radial head fractures, but there is no international standard for which classification is generally preferred.

Type 1 fractures are those in which the bone fragments are not displaced relative to each other.
Type 2, unlike type 1, has a displacement of the bone fragments
Type 3 finally represents the group of comminuted fractures.