Radial Head Fracture

Question 1

What is the most common elbow fracture?

Answer 1

Radial head fractures

Question 2

Epidemiology of Radial head fractures

Answer 2

Account for approx one-third of all elbow fractures

Highest incidence 20-60 years of age

Slightly higher frequence in women

Question 3

Pathophysiology of RHF

Answer 3

At elbow radial head articulates with capitulum of humerus and proximal ulna. It allows flexion/extension and supination/pronation of elbow.

Ligamenets can also be damaged in these injuries which might warrant further clinical and imaging assessment.

Question 4

Mechanism of injury

Answer 4

Indirect trauma

Axial loading of the forearm causing the radial head to be pushed against capitulum of the humerus.

Arm in extension + pronation

Question 5

Clinical features

Answer 5

FOOSH -> Elbow pain

Can be swelling and bruising as well

Question 6

Examination findings

Answer 6

Tenderness over lateral aspect of elbow and radial head

Pain and crepitation on supination and pronation

Elbow effusion or limited supination and pronation

Question 7

Other injuries associated

Answer 7

Wrist ligament and bony injuries from FOOSH

Radial head fractures or dislocation from FOOSH

This means that shoulder and wrist should also be examined.

Question 8

What is an Essex-Lopresti fracture?

Answer 8

Fracture of radial head with disruption of distal radio-ulnar joint as well.

Will always require surgical intervention

Question 9

Investigations

Answer 9

Routine bloods + clotting + Group & Save

Plain AP and lateral radiographs (include joint above and below if needed)

CT imaging for more complex injuries and degree of comminution

MRI if ligament injuries

Question 10

X-ray findings

Answer 10

Sometimes only elbow effusion is visible

Elbow effusion on lateral view = Sail sign

Question 11

Classification system

Answer 11

Mason classification

Question 12

Explain Mason classification

Answer 12

According to degree of displacement and intra-articular involvement

Type 1 - Non-displaced or minimally displaced < 2 mm

Type 2 - Partial articular fracture with displacement > 2mm or angulation

Type 3 - Comminuted fracture and displacement (complete articular fracture)

Question 13

General management

Answer 13

Resuscitation

Stabilisation

Provide adequate analgesia

Question 14

What is treatment guided by?

Answer 14

Severity of fracture (by Mason classification)

Neurovascular compromise

Mechanical block of elbow motion

Question 15

Treatment of Mason Type 1

Answer 15

Conservative

Short period of immobilisation with sling (< 1 week) with early mobilisation

Question 16

Treatment of Mason Type 2

Answer 16

No mechanical block -> Treat as type 1

Mechanical block -> Consider ORIF

Question 17

Treatment of Mason Type 3

Answer 17

Nearly always warrant surgical intervention by ORIF or radial head excision or replacement

Question 18

Prognosis

Answer 18

Usually good but depends obv on severity

Secondary OA can appear later in life