Fractures of the radial head are common and comprise nearly one-third of all fractures around the elbow. Although the majority of these injuries can be treated conservatively, they occasionally require surgery. A common complication of any injury around the elbow is stiffness and the goal of treatment of radial head fractures is to restore early range-of-motion.
Radial head fractures are almost always diagnosed in the emergency department after an examination by the emergency room physician and appropriate imaging. Treatment is based on the severity of the injury. The majority of radial head fractures are minimally displaced and can be treated without an operation. Fractures that are comminuted (in multiple pieces), widely displaced, or are associated with other injuries (elbow dislocations, coronoid fractures, etc) require urgent orthopaedic consultation. Treatment generally takes one the following broad categories:
- Conservative: If you are in the majority of patients with a fracture that does not require surgery, you will require a short period of immobilization, most likely in a sling. Arrangements will be made for you to see an orthopaedic surgeon in fracture clinic within 7-14 days. At that time a repeat x-ray will be obtained to ensure the fracture hasn’t shifted. If the alignment of the fracture is still acceptable, you will be asked to begin working to regain your elbow range of motion.
- Surgery: If you are in the minority of patients that require an operation, there are three broad options for treatment. These are as follows:
- Fragment Excision: If the fracture has caused a small piece of bone to become entrapped within the elbow joint, this will likely cause a mechanical restriction to normal range of motion. In order to restore range of motion, your surgeon may recommend an operation to remove that small piece of bone.
- Open Reduction – Internal Fixation: If the fracture has resulted in two relatively large fragments, your surgeon may recommend an operation to put these back together with small plates and screws. This is generally done through a lateral incision on the elbow although this may change if there are other associated injuries.
- Radial Head Replacement: If the injury has resulted in a fracture in many small pieces then your surgeon will likely recommend an operation to remove the small pieces and replace them with a metallic replacement.
Follow-Up and Rehabilitation
- 0-2 Weeks: The goal of this appointment will be to start working at gentle range of motion. A new x-ray will be obtained to ensure that the fracture hasn’t shifted. You will be cautioned to avoid any strengthening at this stage and should not be lifting anything heavier than a cup of coffee.
- 3-6 Weeks: Another x-ray will be obtained at this appointment to ensure healing is progressing. You will likely be permitted to start doing some gentle strengthening at this point. If your fracture was only minimally displaced and did not require surgery, this may be the last time you are asked to follow-up for this injury.
- 6-12 Weeks: Follow-up in this range is generally reserved for patients that required surgery or if there was a complication noted such as stiffness. A plan will be made based your injury pattern and you will likely be asked to attend formal physiotherapy to optimize your post-operative outcome.
The most frequent complication following this injury is elbow stiffness. Even with relatively minor injuries it is not uncommon to lose the ability to fully straighten your arm. Fortunately, it is uncommon to have stiffness in the range of motion that we typically use for activities of daily living. To decrease the risk of significant elbow stiffness, it is important to start working at your range of motion as early as possible following your injury.
Other complications following this injury are rare. Any fracture that involves a joint does put you at increased risk of post-traumatic arthritis. Fortunately, symptomatic elbow joint arthritis is relatively rare. If you are immobilized for a prolonged period of time, this injury may also predispose you to a condition known as chronic regional pain syndrome. To decrease your risk of this complication it is imperative to begin working at your range of motion as early as possible following your injury.
The outcome following a fracture of the radial head is generally very good. Most patients are left with a pain free elbow and have no restrictions once the fracture has healed. A good outcome is very dependent on re-establishing your elbow range of motion as soon as possible following your injury.