In planning the treatment for radial head fractures a detailed assessment of injuries should be made. The choice of the treatment depends upon patient’s demands, associated medical conditions and conditions, and associated injuries. For operative treatment, further investigations like CT scan can be done to know fracture configuration.

Here is general outline of the treatment options. The treatment needs to be individualized, however.

Type I

These fractures are undisplaced or  displacement of the fracture is less than 2 mm). They do not need to be reduced and heal well by conservative treatment.

The patient can be treated in a simple arm sling or splint depending upon the soft tissue trauma. Active forearm mobilization followed by physiotherapy helps to restore usually good to excellent function.

Some patients might complain slight loss of extension.

With Associated Elbow Dislocation
In  such cases the elbow should be splinted for a greater period and days, usually 3 weeks. Then limited motion is begun and weekly xrays should be done to monitor recurrent dislocation or subluxation of the joint. The care should focus on the dislocation rather than radial head fracture.

Type II

This kind of injury is quite challenging for decision making regarding the treatment.  The treatment varies from  open reduction and internal fixation to excision. Patient profile and demands, associated injuries of the interosseous ligament or elbow dislocation can affect the decision.

If  There Is No Mechanical Block
Type II fractures that have no mechanical block to elbow motuon can be treated similarly to type I. Close follow-up with weekly xrays is must. In dificult  A CT scan may be helpful in evaluating the case and executiing the decision.

If  There Is Mechanical Block
The choice is made between excision and open reduction and fixation of the fracture.  In high-demand patient,preference should be given to open reduction and internal fixation. In the low-demand patient, excision may be better. In older patients excision should be considered as the bone quality does not favor a good fixation. If the condition of the patient does not permit excision it may as well be delayed.

With Associated Injury

Essex-Lopresti Fracture

As for as possible radial head should be preserved. Excision of the radial head may lead to symptomatic proximal migration of the radius in these cases.  Open reduction and internal fixation is a good choice and if not possible radial head prosthesis might be considered to avoid complication of proximal migration of radius.

Despite those observations, logically it would seem appropriate to try to preserve the radial head with ORIF when feasible and replace it with a prosthesis only when needed due to technical inability to obtain rigid fixation.

Elbow Dislocation

It is preferable to preserve the radial head if possible.  Excision should be considered only as a last resort

If the radial head requires excision, repair of the lateral ligament complex is also required.

If the radial head cannot be saved and is excised, the potential for redislocation is high.

Type III

These fractures are not repairable. These fractures possess extensive comminution and displacement and  early excision as the treatment of choice.

Mobilization should be begun early.

With Associated Injury
Essex-Lopresti Fracture

Excision of the radial head and replacement with prosthesis should be considered.

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Related posts:

1. Radial Head Fractures – Clinical Presentation and Treatment
2. Fractures of Radial Head or Head of Radius – The Biomechanics
3. Fracture Of Radial Head – Anteroposterior View of Elbow
4. Classification and Treatment of Olecranon Fractures
5. Dislocation of Elbow With Fracure of Radial Neck – Anteroposterior and Lateral Views