A radial head fracture is a relatively rare fracture – accounting for about 3 percent of all fractures. The fracture occurs primarily because of a fall that occurs on the outstretched arm. In addition to common fractures, there are also complex fractures that sometimes provide concomitant injuries.
What is a radial head fracture?
Radial head fracture is divided into a total of five types. Type 1 is a nondisplaced fracture; this fracture is sometimes the most common form of this rare injury. In type 2, the medical profession refers to a displaced fracture, which is also called a chisel fracture, among other names. Type 2 is when there is a step formation that is more than 2 mm. Type 3 refers to the comminuted fracture. In type 4, the medical profession refers to a non-displaced radial neck fracture and in type 5, a displaced radial neck fracture. Types 4 and 5 are classified according to the Bakalin special form.
Causes
The most common or sole cause that triggers a radial head fracture is a fall on an outstretched or slightly flexed arm. This means that indirect force is always the trigger of a radial head fracture. The fall causes a bony shearing, a straight fracture or can sometimes lead to a comminuted fracture (or a shattering of the radial head). There are no other known causes that may precipitate a fracture consistent with this condition.
Symptoms, complaints, and signs
The patient complains of severe pain. Predominantly, the affected person describes the localization of the pain in the area of the forearm (near the radius) or near the elbow joint, respectively. Many patients also complain of pain in the hand; in this case, it can be assumed that the pain caused by the radial head fracture radiates into the hand. In the further course, there is a severe restriction of the mobility of the elbow joint. The radial head fracture also causes – in the area of the elbow – a significant swelling, which indicates an injury.
Diagnosis and course of the disease
The physician orders an X-ray examination. By means of the imaging procedure, he recognizes whether a fracture is present and what type it is. If the physician cannot clearly see whether there is any displacement of the bone, further examination methods (magnetic resonance therapy (MRI) or a computer tomography) can provide information about the extent to which the radial head is injured. Those imaging methods are also important in that any concomitant injuries can be ruled out. Finally, the humerus or the ulna could be injured. Depending on the type and concomitant injuries, the physician decides whether conservative or surgical treatment or therapy will be performed. The healing time is about six weeks; complications are usually not expected. After therapy, movement is not restricted; consequential damage is not expected.
Complications
A radial head fracture can occasionally lead to complications. Here, physicians distinguish between early-onset and later-onset sequelae. Pseudarthrosis is considered a rather rare effect of the radial head fracture. It is mainly seen in radial neck fractures that have not been sufficiently reduced. In the course of conservative therapy, painful malunion is possible. This results in a permanent malposition or step formation. In the medium term, there is therefore a risk of restricted movement when rotating the forearm and post-traumatic arthrosis of the elbow. In such cases, surgical measures are required. One of the most frequent complications of the radial head fracture is a chronic restriction of movement of the elbow joint. Possible reasons for this are the fracture itself or immobilization for too long. Furthermore, extension deficits in the forearm are possible, which are caused by capsular shrinkage or adhesions. If physiotherapeutic treatment does not bring about any improvement, surgery can also provide relief in this case. Possible early sequelae of radial head fracture include nerve injury, compartment syndrome, or infection. Later complications may include infection or axial misalignment of the bones. Surgery for radial head fracture also carries the risk of complications.This means that adjacent structures can be affected during the procedure. These are mostly ligaments and nerves in the elbow region. In the worst case, this can lead to prolonged periods of disability. Because no absolute success rate can be achieved with the help of surgical procedures, there is also a risk of osteoarthritis.
When should you see a doctor?
When a radial head fracture occurs, a doctor should always be consulted immediately. There is no self-healing, so the condition must be treated by a doctor in any case. This is the only way to avoid complications and ensure proper fusion after the fracture. A doctor should be consulted for a radial head fracture if the patient suffers from very severe pain in the area of the forearm. Especially after a fall or after any other injury in this area, a doctor should be consulted immediately. In emergencies, the emergency doctor should be called or the hospital should be visited. In this case, the pain can also spread to the entire arm and have a very negative effect on the quality of life of the affected person. As a rule, the mobility of the forearm is also significantly restricted by the radial head fracture. If the complaints persist over a longer period of time, a doctor must be consulted. In most cases, an orthopedist can treat the radial head fracture well.
Treatment and therapy
If the patient complains of severe pain or if there is severe effusion, the physician can – using local anesthesia – perform a joint puncture at the beginning of treatment. This largely relieves or reduces the pain. After the swelling has subsided and initial results of the imaging procedures are available, the physician decides whether conservative or surgical therapy and treatment will be chosen. If the physician decides on conservative therapy, the arm is first immobilized. This is done by means of an upper arm plaster splint. The upper arm or elbow is immobilized at an angle of 90 degrees. If there is no displaced fracture, physiotherapeutic exercises can be started after a few days. After a few days, the patient receives a splint instead of a plaster cast, which must be worn for about three weeks. After just under six weeks, the patient is completely healed; freedom of movement should be fully restored – as it was before the accident. Physiotherapeutic exercises are recommended. By means of these exercises, the movement of the joint is promoted or the same range of motion as before the accident is restored. Late effects are not to be expected – even if no physiotherapeutic exercises are used. If no conservative therapy is possible, medical experts will decide what kind of surgery to perform in order to achieve a perfect result. Predominantly, a radial head resection is performed. This surgical method is used, for example, in comminuted fractures. If a complex or severe fracture is present, the physician opts for a radial head prosthesis. In this procedure, the injured radial head is replaced by a prosthesis. Here, too, the healing time is about six weeks; even after the operation, it is advantageous if any physiotherapeutic measures are taken so that complete freedom of movement is restored. There are – as a rule – no complications.
Prevention
In the final analysis, the radial head fracture cannot be prevented at all. It is important that the affected person avoids falls, respectively, does not want to catch himself with the outstretched arms. However, since this is a reflex action, it is almost impossible – in the context of a fall – not to want to intercept oneself with the hands. In older people or people suffering from bone diseases (e.g. osteoporosis), fractures of the radial head can occur more frequently if they try to catch themselves with their outstretched arms during a fall. In this case, the probability of any accompanying injuries also increases.
Aftercare
The type and intensity of aftercare for a radial head fracture depends on the conservative or surgical therapy used. Following conservative therapy with a splint, it is important to remobilize the elbow joint as soon as possible. This is to avoid permanent movement restrictions.The aim is to regain full mobility after about six weeks. If this is successful and no pain occurs, no further aftercare treatment is required. In the case of surgical treatment of the radial head fracture, follow-up treatment begins as early as seven to ten days after immobilization of the elbow using a splint. Aftercare begins carefully with passive stretching exercises, i.e. without the patient’s own muscle strength. It is important to be patient, because full extension of the elbow should not be achieved before four weeks have passed. The actual strength training to rebuild the muscles does not begin until eight to twelve weeks after the hernia has been surgically repaired. If muscle training is started too early, the risk of permanently restricting elbow motion increases and should be avoided. Once full range of motion and muscle rebuilding has been achieved, no further follow-up treatment or follow-up is necessary.
What you can do yourself
After a radial head fracture, concomitant measures such as rest and sparing apply. Patients should cool any swelling or effusion and follow the physician’s instructions regarding physical exertion. The patient should talk to the doctor about natural painkillers to support the drug therapy Physiotherapy, but also exercises from yoga or Pilates are good ways to support recovery. Affected persons should not lift any loads for the time being and should not stretch or bend the arm too much. In addition, the prescribed medication must be taken. Other measures focus on taking it easy on the fracture and watching for unusual symptoms. Because a fracture of the radial head is associated with limited movement of the arm, assistive devices such as crutches may be needed. If the radial cup fracture occurred as part of an accident, therapy may also be appropriate. For example, trauma and psychological problems must be clarified before serious mental illnesses such as depressive moods or anxiety develop from them. If the above-mentioned measures are carried out constantly, the injury will quickly subside. However, if complications occur that cannot be alleviated by self-help measures, the physician should be consulted.
