Radial Head Fractures – Clinical Presentation and Treatment
March 15, 2009 by Dr Arun Pal Singh
Filed under Elbow Injuries, Fractures-Dislocations
A fracture of the head of radius presents with pain and swelling in the elbow region. There may be associated injuries to the structures in the neighborhood. These include distal humeral region, upper end of ulna. Radial head fractures are seen in quite a number of elbow dislocations.
The diagnosis may be difficult to make on clinical examination. Radiograms are required to confirm the diagnosis.X-rays in the anteroposterior, lateral, and oblique planes of the elbow are usually sufficient to diagnose the fracture.
A radio-capitellar view may be helpful inn doubtful cases (minimally or nondisplaced fractures)
Radiocapitellar view
Forearm in neutral rotation and the x-ray tube angles 45 degrees cephalad
Alterrnativelhy modified radial-head capitellum view may be taken to identified undisplaced or minimally displaced fractures
Modified Radial-Head Capitellum view
This view is taken with the posterior aspect of the supinated forearm in contact with the cassette and the elbow slightly flexed. The beam is directed 45 degrees mediolaterally
CT scanshelps in estimating the fracture size, degree of fragmentation, and displacement and give better understanding for planing for surgery.
Treatment of Radial Head Fractures
As for as possible, radial head should be preserved due to risk of proximal migration of radius. Excision can be considered a treatment in old persons with lesser demands from elbow.
Following factors are considered when planning for radial head fracture treatment.
- Demand : In low demand situations, excision of fragements can be considered but in active elbows wih high demand of use, radial head should be preserved whenever possible.
- Associated injuries would affect treatment decision.
Prosthetic replacement is being increasingly done but enough data is not yet available to support or refute this.
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