Radial Head Fractures of the elbow

The elbow joint is made up of three bones:
•    The humerus (arm bone),
•    The ulna (forearm bone on the side of the little finger),
•    The radius (forearm bone on the thumb side).
At the elbow, the radius extends into the radial head, which articulates with part of the distal humerus called the capitellum. This joint carries 60% of the load passing through the elbow. The radial head is disc-shaped and covered almost entirely with cartilage. It plays an important biomechanical role in elbow stability.

Radial head fractures are a common injury, accounting for 20-30% of elbow fractures. They occur most frequently in adults between the ages of 30 and 60.

Fractures of the radial head most often occur as a result of trauma, typically in everyday or sporting accidents. The most common mechanism is an indirect impact, when the patient lands on the hand with the arm outstretched. In this position, the radial head is broken by impact against the humerus. In more than 30% of cases, radial head fractures are associated with fractures of other elbow bones, elbow dislocation, torn elbow ligaments or wrist fractures. These more complex injuries carry a risk of sequelae if they are not diagnosed and treated early and appropriately. Their diagnosis requires expertise and a high degree of clinical suspicion.

The most common symptoms of a radial head fracture are:
•    Pain on the outside of the elbow
•    Difficulty moving the elbow in all directions
•    Swelling of the elbow
These symptoms usually appear suddenly following trauma.

Clinical examination and standard X-rays of the elbow are generally sufficient to establish the diagnosis, and clinical attention is particularly necessary to detect any associated lesions. Advanced imaging studies, typically a CT scan of the elbow, may be indicated on a case-by-case basis. MRI is not generally necessary in the management of radial head fractures.

The treatment options for a radial head fracture depend on the type of fracture and any associated injuries.

In all cases, the aim of the treatment is to recover a stable, mobile and pain-free joint. Depending on the diagnosis, the elbow surgeon will recommend the treatment best suited to the type of fracture and the patient's functional requirements. Whatever the case, a treatment plan should be drawn up quickly to avoid any after-effects. 

Conservative treatment :

Conservative treatment is generally indicated for isolated fractures of the radial head that are not or only slightly displaced without blocking rotational movement of the forearm (pronation/supination). Puncture of the haematoma with concomitant infiltration of local anaesthetic may be performed acutely to assess mobility and any mechanical block. 
Conservative treatment consists of immobilisation with a splint or sling for short-term pain relief and immediate resumption of mobility with physiotherapy follow-up and self-mobilisation exercises several times a day. 
The result is excellent in over 90% of cases with well-managed conservative treatment. The main risk of complication is elbow stiffness in the event of prolonged immobilisation or late management.

Surgical treatment :

Surgical treatment is most often indicated in cases of radial head fracture with displacement, several fragments, blocking of rotational movement of the forearm and associated lesions. Treatment most often consists of osteosynthesis*reconstruction and fixation of fragments or replacement of the radial head with a prosthesis when the number of fragments is too large and/or the fracture is non-reconstructible. Surgical treatment, regardless of the technique used to treat the radial head fracture, allows free and immediate mobilisation of the elbow in all directions. Associated injuries are treated on a case-by-case basis. The functional result is good to excellent in over 90% of cases. Diagnosis and appropriate treatment of associated lesions is crucial to the final result.

Surgery is generally safe and controlled, but like any operation, it carries a risk of potential complications. These complications are generally rare and specific to the surgical technique. They may include, for example:

• Numbness and/or weakness of the forearm, wrist or hand may temporarily occur. 
• Additional bone (heterotopic ossifications) may form near the surgical site. This usually results in little or no limitation of range of movement. However, when the limitation is significant enough to have a functional impact, it may require further surgery.

Intense pain near the elbow, difficulty moving the arm after a trauma, swelling and significant bruising all call for rapid consultation. Early diagnosis and treatment are essential to optimise the chances of recovery.

Fractures of the radial head of the elbow are diagnosed during a clinical examination supplemented by a medical imaging examination. Depending on the type of fracture and any associated lesions, surgery may be planned. In all cases, post-operative rehabilitation is recommended to restore mobility and function to the elbow joint.

1. What are the main symptoms of a radial head fracture?
The main symptoms of fractures of the radial head of the elbow are intense pain in the elbow, swelling, haematoma and difficulty moving the elbow in all directions.

2. What are the treatment options for a radial head fracture? 
The treatments of radial fractures depends on their complexity and type. Minor fractures are treated conservatively with early mobilisation. Severe fractures or fractures with complications require surgery, either by fixation or prosthetic replacement.

3. What are the risks of complications after a radial head fracture?
The risk of complications is low when the diagnosis is made correctly and appropriate treatment is started early. The type of complication is specific to each treatment method. Stiffness and instability are common complications if treatment is incomplete or delayed.

4. How long does rehabilitation last after a radial head fracture?
Re-education is essential to ensure functional recovery. Hôpital de la Tour offers highly specialised, multidisciplinary treatment for elbow pathologies. Recovery time depends on the severity of the injury, ranging from 6 weeks for the most benign radial head fractures to 6 months for more serious injuries.