Radial head fracture: Difference between revisions
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{{Adult top}} [[radial head fracture (peds)]].'' | |||
==Background== | ==Background== | ||
[[File:Gray329.png|thumb|Left elbow-joint with anterior and ulnar collateral ligaments]] | [[File:Gray329.png|thumb|Left elbow-joint with anterior and ulnar collateral ligaments]] | ||
| Line 34: | Line 34: | ||
[[File:RadHeadFracMark.png|thumb|Radial head fracture (red arrow) with posterior and anterior sail signs (blue arrows)]] | [[File:RadHeadFracMark.png|thumb|Radial head fracture (red arrow) with posterior and anterior sail signs (blue arrows)]] | ||
[[File:Ant and post fat pad.png|thumb|Anterior and posterior fat pad signs (in a case of an undisplaced fracture of the radius head, which is not visible directly).]] | [[File:Ant and post fat pad.png|thumb|Anterior and posterior fat pad signs (in a case of an undisplaced fracture of the radius head, which is not visible directly).]] | ||
*Ensure there is no tenderness over the rest of the forearm/wrist to rule out an [[Essex-Lopresti fracture]] | *Ensure there is no tenderness over the rest of the forearm/wrist, to rule out an [[Essex-Lopresti fracture]] | ||
*Typically diagnosed on [[elbow X-ray]] (''fractures are often subtle'') | *Typically diagnosed on [[elbow X-ray]] (''fractures are often subtle'') | ||
**Look for abnormal fat pad | **Look for abnormal fat pad | ||
Revision as of 21:53, 22 June 2020
This page is for adult patients. For pediatric patients, see: radial head fracture (peds).
Background
- Most common fractures of the elbow, approximately 20% of elbow fractures
- Caused by FOOSH in pronation leading to radial head being driven into the capitellum
Associated injuries (are common)
- Capitellum fracture
- Olecranon fracture
- Coronoid fracture
- MCL injury
- Elbow dislocation
- DRUJ (distal radial ulnar joint) injury
- Interosseous membrane disruption
- Essex-Lopresti fracture (radial head fracture, DRUJ, interosseous membrane disruption), requires ORIF
- Terrible triad (radial head fracture, coronoid fracture, elbow dislocation)
Clinical Features
- Pain in the lateral elbow, especially with pronation/supination of forearm
- Swelling laterally and tenderness of radial head
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
Workup
- Elbow PA & lateral
- Consider x-rays of humerus, forearm, and wrist (e.g. to rule out a Essex-Lopresti fracture)
- Consider Greenspan (radial head-capitellum) view X-Ray
- Lateral elbow is shot at 45 degrees to pick up subtle fractures
Diagnosis
- Ensure there is no tenderness over the rest of the forearm/wrist, to rule out an Essex-Lopresti fracture
- Typically diagnosed on elbow X-ray (fractures are often subtle)
- Look for abnormal fat pad
- Look for radiocapitellar line disruption
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
- Ice, elevation
Immobilization
- Sling immobilization in flexion
- Nondisplaced fracture with no mobility restrictions: ortho follow up within 1wk
- Displaced fracture or mobility restrictions: ortho follow up within 24hr
Disposition
- Normally outpatient