Radial head fractures are common injuries. They account for approximately 20% of all acute elbow injuries. They are more frequent in women than in men and occur more likely between the ages of 30 and 40.
Typically, the hands are extended out to break a fall and the force of the fall travels up the forearm bones, fracturing or dislocating the elbow. Sometimes, it also breaks the radius, the smaller bone in the forearm. These radial fractures usually occur in the part of the bone near the elbow called the radial head.
Common symptoms of radial head fractures include:
- Outside elbow pain
- Elbow joint swelling
- Pain and difficulty bending or straightening elbow
- Difficulty turning the forearm
The radial head is the bulbous end of the radius where it meets the elbow
Dr. Stowell will classify your fracture according to the degree of its displacement or how far out it is from the normal position of the bone as well as the number of fragments there are. Fractures are classified accordingly:
Type I Fracture – bone fragments remain fitted together but small cracks are present. Dr. Stowell may order an X-ray a few weeks after the injury, as they are not usually visible on initial X-rays. He may also have you use a splint or sling for a few days to stabilize your elbow and advise gradual movement in your elbow and wrist. Too much motion and too quickly can further displace the bones.
Type II Fractures – fractures are slightly displaced and involve a larger piece of bone. If Dr. Stowell finds that your displacement is minimal, he may advise wearing a sling or splint for 1 to 2 weeks. He may further advise range-of-motion exercises depending on your level of pain. Dr. Stowell may advise surgery to remove small fragments of broken bone if they inhibit normal elbow movement or there is potential for long-term problems with your elbow. If your elbow fragments are large and displaced enough, then Dr. Stowell may attempt to hold the bones together with screws or a plate and screws; however, if this is not possible, Dr. Stowell may remove the broken pieces of the radial head. During surgery, Dr. Stowell may also correct other soft-tissue issues he observes such as a torn ligament.
Type III Fractures – multiple fragments of bone that often cannot be put back together. Typically, in Type III radial head fractures, there is significant damage to the elbow joint and the ligaments surrounding it. Dr. Stowell will recommend surgery to either fix or remove the broken pieces of bone and repair the soft-tissue damage. If the damage is severe enough, Dr. Stowell may need to remove the entire radial head and replace it with an artificial radial head to improve long-term function. He will advise range-of-motion exercises, stretching and bending your elbow gently in order to avoid stiffness. After surgery, you will be advised to bear minimal weight through the arm for up to 6 to 12 weeks. You may also be placed in a splint or cast for several weeks after surgery.
Some loss of movement in the elbow with even the simplest of fractures may occur. In some cases, a second surgery to remove scar tissue may be necessary if your elbow stiffness restricts your movement. If Dr. Stowell recommends Physical Therapy, he will work closely with his PT team to prescribe exercises for you to restore movement and strength so that you can resume full activities.