Therapy

The fracture of the radial head can be treated either conservatively or surgically. Which of the two procedures is chosen is decided according to the type and extent of the injury. If it is a simple fracture without displacement of the bone fragments, successful conservative treatment is often possible.

In the case of comminuted fractures, open fractures, concomitant injuries, or greater displacement of the bone fragments relative to each other, surgical treatment of a radial head fracture is generally recommended. In the same procedure, the possible concomitant injuries can then be treated. If surgery is not required, the arm is usually immobilized in an upper arm cast.

The elbow is fixed in a 90° position. It is important to mobilize the elbow joint at an early stage, otherwise it may stiffen. In many cases of conservatively treatable radial head fractures, the first physiotherapeutic exercises can be started after a few days.

After the plaster treatment, a plastic splint is used to stabilize the elbow for some time. All in all, the conservative therapy including the physiotherapeutic exercises takes about six weeks until the elbow is largely free of symptoms. In case of a very severe limitation of movement due to a joint effusion, there is also the possibility of a therapeutic joint puncture as a conservative measure.

In this procedure, the fluid is drained from the joint through a cannula under local anesthesia. This is often a great relief for the patient. At grade 2 and 3, when bone fragments have shifted against each other, surgery should be performed to avoid complications and faulty healing.

In this case, the fragments are brought back into the correct position and then fixed by screws. Surgery for a radial head fracture is therefore necessary if the fracture is unstable, if the bone fragments have shifted significantly against each other, or if there is a restriction in forearm rotation. The bone fragments are then surgically repositioned to their anatomically correct position and fixed with plates or screws.

In the case of pronounced comminuted fractures, it may be advisable to remove the entire radial head and replace it with a prosthesis in order to achieve better functionality of the elbow joint. After the operation, the arm is fixed in a plaster splint for up to ten days before physiotherapeutic exercises are started. The exercises are performed with increasing intensity and range of motion. After six to eight weeks, an almost normal level of function should be achieved again. Overall, good results are achieved with the surgical procedures, but in the long term, certain movement restrictions may remain, both with surgical and conservative therapy measures.