Radial Head Fractures

Incidence

• Fracture of the radial head can restrict forearm rotation, compromise the stability of the forearm or elbow, and in relatively rare cases, cause radiocapitellar arthrosis.

Classification

Aetiology

Pathology

History

• Low Energy vs High Energy

Examination

Investigations

Xrays

Treatment

Aims

• The primary goal of treatment is to ensure forearm rotation.
• Incongruity of the radial head in the proximal radioulnar joint causes loss of rotation.

Depends on Injury Pattern

• Isolated Partial Radial-Head Fractures
  • slightly displaced
    • do well with non-operative management
    • does it cause a block to forearm rotation?
      • difficult to assess in acute setting
        • Options
          1. Aspirate haemarthrosis and inject local anaesthetic to examine
          2. Reassess 4-5 days after injury
• Partial Radial-Head Fracture as Part of a Complex Injury
  • Pattern
    1. anterolateral aspect of the radial head is fractured with resultant loss of the anterior buttress of the ulnohumeral joint.
    2. Displaced, partial radial-head fractures are common among patients with posterior olecranon fracture dislocations – older, osteoporotic women
• Fractures Involving the Entire Head of the Radius

Nonoperative

Operative

• ORIF
  • Indications
    • retaining the fractured radial head amidst complex combined injury with instability of the forearm or elbow,
      1. Essex-Lopresti injury (radial head fracture and rupture of the interosseous ligament of the forearm)
      2. terrible triad injury (posterior dislocation of the elbow with fractures of the radial head and coronoid process)

Complications

• Stiffness
  • Operative fixation can restrict forearm rotation either via
    1. implant prominence,
    2. scarring,
    3. heterotopic bone formation
• Nerve
  • PIN
    • How to avoid
      1. retractors should not be placed around the radial neck,
      2. the forearm should be pronated during exposure of the radial neck
      3. In distal dissection and internal fixation are needed, the nerve should be identified and protected.
• Instability
  • Injury to the lateral collateral-ligament complex, leading to posterolateral, rotatory, elbow instability

Prognosis

• Fracture of the radial head can restrict forearm rotation, compromise the stability of the forearm or elbow, and in relatively rare cases, cause radiocapitellar arthrosis.
• Radial Head Excision:
  • the incidence, severity, and consequences of proximal migration of the radius after excision of isolated radial-head fractures have long been a source of debate