How Slang

A radial head fracture is – with around 3 percent of all bone fractures – a relatively rare fracture. The fracture occurs primarily as a result of a fall on an outstretched arm. In addition to the usual fractures, there are also complex fractures, which sometimes also cause accompanying injuries.

What is a radial head fracture?

The radial head fracture is divided into five types. Type 1 is an undisplaced fracture; this fracture is one of the most common forms of this rare injury. In type 2, the doctor speaks of a displaced fracture, which is also called a chisel fracture. Type 2 is when there is a step formation that is more than 2 mm. Type 3 denotes the comminuted fracture. In type 4, the doctor speaks of a non-displaced radial neck fracture and in type 5 of a displaced radial neck fracture. Types 4 and 5 are classified according to the Bakalin special form. See AbbreviationFinder for abbreviations related to Radius Head Fracture.

Causes

The most common or only cause that triggers a radial head fracture is a fall on an extended or slightly bent arm. This means that an indirect force is always the trigger for a radial head fracture. The fall causes a bony shearing off, a straight fracture or can sometimes also lead to a comminuted fracture (or a shattering of the radial head). Other causes that can trigger a corresponding fracture are not known.

Symptoms, Ailments & Signs

The patient complains of severe pain. The affected person mainly describes the localization of the pain in the area of ​​the forearm (near the radius) or in the vicinity of the elbow joint.

Many patients also complain of hand pain; here it can be assumed that the pain caused by the radial head fracture will radiate into the hand. As the disease progresses, the mobility of the elbow joint is severely restricted. The radial head fracture also causes – in the area of ​​the elbow – a significant swelling, which indicates an injury.

Diagnosis & course of disease

The doctor orders an x-ray. Using the imaging procedure, he can see whether there is a fracture and what type it is. If the doctor cannot clearly see whether the bone has shifted, other examination methods (magnetic resonance therapy (MRI) or computed tomography) can provide information about the extent to which the radial head is injured.

These imaging procedures are also important in that any concomitant injuries can be ruled out. Finally, the humerus or the ulna could be injured. Depending on the type and accompanying injuries, the doctor decides whether conservative or surgical treatment or therapy is to be carried out. The healing period is around six weeks; Complications are usually not to be expected. After therapy, movement is not restricted; Consequential damage is not to be expected.

Complications

A radial head fracture can occasionally lead to complications. Doctors distinguish between earlier and later occurring sequelae. Pseudarthrosis is considered a rather rare effect of radial head fractures. It is particularly evident in radial neck fractures that have not been adequately reduced.

In the context of conservative therapy, painful improper healing is possible. This results in a permanent malposition or step formation. In the medium term, there is a risk of restricted movement when turning the forearm and post-traumatic arthrosis of the elbow. In such cases, operational measures are required.

One of the most common complications of a radial head fracture is a chronic restriction of movement of the elbow joint. Possible reasons for this are the fracture itself or prolonged immobilization. Stretch deficits in the forearm are also possible, which are caused by capsule shrinkage or adhesions. If the physiotherapy treatment does not bring any improvement, an operation can also help here.

Possible early sequelae of a radial head fracture are nerve injuries, compartment syndrome or infections. Later complications can be infections or misalignments of the bones. Surgery for a radial head fracture also carries the risk of complications.

Adjacent structures can be affected during the intervention. These are mostly ligaments and nerves in the elbow region. In the worst case, there are longer failures. Because no absolute success rate can be achieved with the help of surgical procedures, there is also the risk of arthrosis.

When should you go to the doctor?

In the case of a radial head fracture, a doctor should always be consulted immediately. It does not heal itself, so the disease must be treated by a doctor in any case. This is the only way to avoid complications and ensure proper healing after the fracture. A doctor should be consulted for a radial head fracture if the patient suffers from very severe pain in the forearm area. A doctor should be consulted immediately after a fall or other injury in this area.

In emergencies, you should call an ambulance or go to the hospital. The pain can also spread to the entire arm and have a very negative effect on the quality of life of the person concerned. As a rule, the mobility of the forearm is also significantly restricted by the radial head fracture. If the symptoms persist for a longer period of time, a doctor must be consulted. In most cases, an orthopedist can treat radial head fractures well.

Treatment & Therapy

If the patient complains of severe pain or if there is severe effusion, the doctor can perform a joint puncture at the beginning of the treatment using local anesthesia. This largely relieves or reduces the pain.

After the swelling has gone down and the first results of the imaging procedures are available, the doctor decides whether conservative or surgical therapy and treatment should be chosen. If the doctor decides in favor of conservative therapy, the arm is first immobilized. This is done using an upper arm plaster splint. The upper arm or elbow is immobilized at an angle of 90 degrees.

If there is no displaced fracture, physiotherapy exercises can be started after a few days. After a few days, the affected person receives a splint instead of the plaster cast, which must be worn for around three weeks. Complete healing is achieved after almost six weeks; the freedom of movement should – as before the accident – be fully restored. Physiotherapeutic exercises are recommended.

With these exercises, the movement of the joint is promoted or the same range of motion as before the accident is restored. Long-term effects are not to be expected, even if no physiotherapeutic exercises are used.

If conservative therapy is not possible, physicians decide what type of operation is to be carried out so that a perfect result can be achieved. A radial head resection is mainly performed. This surgical method is used, for example, for comminuted fractures. If there is a complex or severe fracture, the doctor decides on a radial head prosthesis.

In this procedure, the injured radial head is replaced with a prosthesis. Here, too, the healing time is around six weeks; Even after the operation, it is an advantage if any physiotherapeutic measures are taken so that complete freedom of movement is restored. There are – usually – no complications.

Prevention

Ultimately, the radial head fracture cannot be prevented at all. It is important that the person concerned avoids falls or does not want to catch themselves with outstretched arms. However, since this is a reflex action, it is almost impossible – in the context of a fall – not to want to catch yourself with your hands.

In older people or people who suffer from bone diseases (e.g. osteoporosis), radial head fractures can occur more frequently if they want to catch themselves with their outstretched arms – as part of the fall. In this case, the probability of any accompanying injuries also increases.

Aftercare

The type and intensity of follow-up treatment for a radial head fracture depend on the conservative or surgical therapy used. Following conservative therapy with a splint, it is important to mobilize the elbow joint again as early as possible. This is to avoid permanent movement restrictions.

The goal is to regain full mobility after about six weeks. If this is successful and there is no pain, no further follow-up treatment is necessary. In the case of surgical treatment of the radial head fracture, the follow-up treatment begins seven to ten days after the elbow has been immobilized with a splint.

Aftercare begins carefully with passive stretching exercises, i.e. without your own muscle strength. It’s important to be patient, because full extension of the elbow shouldn’t be achieved before four weeks. The actual strength training to rebuild the muscles only begins eight to twelve weeks after the surgical repair of the fracture.

If the muscle training is started too early, the risk of permanent restricted movement of the elbow increases and should therefore be avoided. Once full mobility and muscle recovery have been achieved, no further follow-up treatment or follow-up examination is necessary.

You can do that yourself

After a radial head fracture, accompanying measures such as rest and protection apply. Patients should cool any swelling and bruising and follow the physician’s exercise regimen. The patient should talk to the doctor about natural pain relievers to support drug therapy. Physical therapy, but exercises from yoga or Pilates are also good ways to aid recovery.

Those affected should not lift any loads for the time being and should not stretch or bend their arm too much. In addition, the prescribed medication must be taken. Other measures focus on resting the fracture and looking for unusual symptoms. Since a fracture of the radial head is associated with restricted movement of the arm, aids such as crutches may be required.

If the radial head fracture occurred as part of an accident, therapy may also make sense. Trauma and psychological problems must be clarified before serious mental illnesses such as depressive moods or fears develop from them. If the measures mentioned are carried out consistently, the injury will subside quickly. Should complications nevertheless arise that cannot be alleviated by self-help measures, the doctor must be involved.