Radial head fracture: Difference between revisions
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{{Adult top}} [[radial head fracture (peds)]].'' | |||
==Background== | ==Background== | ||
[[File: | [[File:Gray329.png|thumb|Left elbow-joint with anterior and ulnar collateral ligaments]] | ||
*Most common fractures of the elbow, approximately 20% of elbow fractures | *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 | *Caused by FOOSH in pronation leading to radial head being driven into the capitellum | ||
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*DRUJ (distal radial ulnar joint) injury | *DRUJ (distal radial ulnar joint) injury | ||
*Interosseous membrane disruption | *Interosseous membrane disruption | ||
*Essex-Lopresti fracture (radial head fracture, DRUJ, interosseous membrane disruption), requires ORIF | *[[Essex-Lopresti fracture]] (radial head fracture, DRUJ, interosseous membrane disruption), requires ORIF | ||
*Terrible triad (radial head fracture, coronoid fracture, [[elbow dislocation]]) | *Terrible triad (radial head fracture, coronoid fracture, [[elbow dislocation]]) | ||
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==Evaluation== | ==Evaluation== | ||
[[File:RadHeadCTMark.png|thumb|Radial head fracture seen on 3D CT reconstruction.]] | |||
===Workup=== | ===Workup=== | ||
*Elbow PA & lateral | *[[Elbow X-ray|Elbow PA & lateral]] | ||
*Consider x-rays of humerus, forearm, and wrist (e.g. to rule out a [[Essex-Lopresti fracture]]) | *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 | *Consider Greenspan (radial head-capitellum) view X-Ray | ||
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[[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 | ||
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==Management== | ==Management== | ||
*Sling immobilization in flexion | {{General Fracture Management}} | ||
*Ice, elevation | |||
===Modified Mason Type=== | |||
Managment is often based on the Modified Mason classifications<ref>Seung Min Ryu et al.Treatment of Modified Mason Type III or IV Radial Head Fracture: Open Reduction and Internal Fixation versus Arthroplasty. Indian J Orthop. 2018 Nov-Dec; 52(6): 590–595.</ref> | |||
*'''Type I''' - Nondisplaced or minimally displaced (<2mm) with supination and pronation intact or only limited by pain but not due to fracture | |||
**Immobilization with posterior long arm splint and sling in flexion and non-operative | |||
* '''Type II''' - Displaced >2mm or angulated, possible mechanical limitation to forearm rotation due to the fracture fragment | |||
**Immobilization with posterior long arm splint and sling in flexion and operative follow-up for ORIF | |||
*'''Type III''' - Comminuted and displaced causing mechanical disruption to rotational motion | |||
**Immobilization with posterior long arm splint and sling in flexion and operative follow-up for ORIF | |||
*'''Type IV''' -Radial head fracture with associated elbow dislocation | |||
**Urgent coordination for ORIF or radial head arthroplasty due to need for annular ligamentous repair | |||
===Immobilization=== | |||
*Sling immobilization in flexion | |||
*Nondisplaced fracture with no mobility restrictions: ortho follow up within 1wk | *Nondisplaced fracture with no mobility restrictions: ortho follow up within 1wk | ||
*Displaced fracture or mobility restrictions: ortho follow up within 24hr | *Displaced fracture or mobility restrictions: ortho follow up within 24hr | ||
Latest revision as of 20:33, 28 October 2023
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
Modified Mason Type
Managment is often based on the Modified Mason classifications[1]
- Type I - Nondisplaced or minimally displaced (<2mm) with supination and pronation intact or only limited by pain but not due to fracture
- Immobilization with posterior long arm splint and sling in flexion and non-operative
- Type II - Displaced >2mm or angulated, possible mechanical limitation to forearm rotation due to the fracture fragment
- Immobilization with posterior long arm splint and sling in flexion and operative follow-up for ORIF
- Type III - Comminuted and displaced causing mechanical disruption to rotational motion
- Immobilization with posterior long arm splint and sling in flexion and operative follow-up for ORIF
- Type IV -Radial head fracture with associated elbow dislocation
- Urgent coordination for ORIF or radial head arthroplasty due to need for annular ligamentous repair
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
See Also
References
- ↑ Seung Min Ryu et al.Treatment of Modified Mason Type III or IV Radial Head Fracture: Open Reduction and Internal Fixation versus Arthroplasty. Indian J Orthop. 2018 Nov-Dec; 52(6): 590–595.