Radial Head Fracture
What is a Radial Head Fracture?
A radial head fracture is a break in the radial head, the region closer to the elbow. This area is crucial for elbow stability, forearm rotation (pronation & supination), and load transmission from the wrist to the elbow. It is the most common elbow fracture in adults.
Relevant Anatomical Structures
The bones that compromise this area include the radius, ulna, and humerus. Other structures include the radiocapitellar joint, proximal radioulnar joint, humeroulnar joint, Biceps brachii, Supinator, and the Pronator teres. The elbow is a very complex structure that is comprised of various soft tissue structures. Guidance from a therapist that specializes in orthopedic care of the Upper Extremity is essential for proper healing.
What are some of the causes of a radial head fracture?
Radial head fractures can occur due to a fall on an outstretched hand (FOOSH) with the elbow partially flexed or an axial load transmitted through the radius. Other causes include a direct blow to the lateral elbow, high-energy trauma (sports, car accident), or associated injuries (elbow dislocation).
What are the symptoms of a radial head fracture?
Symptoms include lateral elbow pain, swelling, pain with forearm rotation, limited elbow extension, tenderness over radial head, and a possible mechanical block. Red flags to be aware of include increased wrist pain and nerve symptoms such as tingling and/or numbness (rare but serious).
How is a radial head fracture diagnosed?
A radial head fracture can be diagnosed by a physician with a clinical exam, X-rays (AP, lateral, oblique), and CT scan for complex or surgical planning. A radial head fracture can be classified as (type I) nondisplaced or minimally displaced, (type II) displaced or angulated, (type III) comminuted, and (type IV) radial head fracture with elbow dislocation.
What are the treatment options for a radial head fracture?
Treatment will depend on the fracture type, stability, associated injury, physician preference/recommendation. Non-surgical intervention may be initiated if the fracture is classified as type I or type II without a mechanical block. Patients may be provided with a sling, brace, or custom splint for protection of healing structures. Patients may also be provided exercises for early active motion (as indicated by physician). Pain and edema management are also addressed. Surgical intervention may be indicated if there is a mechanical block to elbow motion, displaced or unstable fractures, comminuted fractures, or any elbow instability.
What is the rehabilitation of a radial head fracture
Rehabilitation will need to be closely monitored and progressed by an Occupational/Physical Therapist or Certified Hand Therapist. Early motion is vital for recovery and return to function after a radial head fracture. During the first visit, the patient may undergo brief immobilization of the elbow in combination with active motion of the hand, wrist, and shoulder. Edema control and pain management will also be a high priority during this phase. During the second phase of rehabilitation (week 1-6), active and active assisted range of motion of the elbow will be initiated as well as forearm range of motion. Patients should continue to avoid heavy loading. During weeks 6-12, strengthening may be initiated. The patient will progress strengthening and gradually return to prior level of function.
The rehabilitation process and timeline will vary based on multiple factors such as instability, delayed healing, or other guidelines from the surgeon. It is important that you see a therapist that specializes in Orthopedic care of the Upper Extremity such as a Certified Hand Therapist, to ensure proper progression through the rehab process to avoid re-injury.
