Radial head and neck

General

 Radial head and neck fractures are common.

 They occur usually when you fall on the straight outstretched arm.

 The radial head is the bone in the elbow that allows the forearm to rotate, allowing you to ask for change (supination) and show the back of your

hand (pronation).

Diagnosis

Pain is usually felt deep within the elbow and towards the outer (lateral) side of the elbow.

The elbow may be swollen.

 Movement of the elbow is limited and painful, particularly rotation of the forearm.

X rays are needed to be sure if it is broken or not.

Occasionally the break (fracture) is not seen on the x rays if it is just a little crack in the head.

The doctor may comment that there are elevated "fat pads".

"Fat pads" are shadows in the elbow that show there is fluid in the elbow. This suggests a bone has been

broken in the elbow, but the crack may be too small to be seen on an xray.

In adults "fat pads" often mean there is a small crack in the radial head. (Note in children "fat pads" suggest a

different kind of fracture - supracondylar fracture.

 In complex injuries where the elbow has also been dislocated or if the head is broken into a number of pieces a CT scan might be needed.

Treatment

Treatment depends on how badly the radial head or neck is broken, ie. how far apart the pieces are and how many pieces it has broken into.

Undisplaced

 Undisplaced fractures are where the fracture fragments are in a good position and not separated.

These are treated without an operation and early movement is encouraged.

 See Cambridgeelbow - patient information - stiff elbow on advice on getting the elbow moving.

Displaced or multifragmentary fractures

 Displaced fractures are where the fracture pieces have moved far apart and are likely to jam the elbow movement.

Multifragmentary fractures are where the head has broken into several pieces.

Treatment is variable depending on how amenable the fracture is to fixation:

 Treatment options include:

•

 Non operative treatment - Letting mother nature heal it up, early movement is encouraged. It is always possible to excise or replace the radial

head at a later date.

•

Radial head reconstruction - If broken into three or less pieces and the pieces are big enough with good quality bone it may be possible to re

build the head with special plates and screws

•

Radial head excision - Simply excising the radial head, removing the broken head fragments so they don't jam up the elbow. This can be done

acutely or later as a salvage procedure

•

Radial head replacement - Replacing the radial head with an artificial metal radial head.

Outcome

The outcome is variable, elbows are fairly intolerant of injury.

 Even in undisplaced fractures stiffness may remain in the elbow for a long time. Extension (getting your arm straight) often takes a very long time.

 See cambridgeelbow and the stiff elbow for advice on getting the elbow moving.

Radial Neck fractures

 Most radial neck fractures are undisplaced and are treated non operatively. Early movement is encouraged as comfort allows.

 A little bit of movement stimulates healing, too much slows it down.

 If the head fragment has displaced then surgery is considered to place the head back onto the shaft with special plates and screws.