[10] Radial Head Fractures

Question 1

What proportion of elbow fractures are radial head fractures?

Answer 1

1/3

Question 2

Which age group has the highest incidence of radial head fractures?

Answer 2

Those between 20-60 years of age, with a slightly higher incidence in females

Question 3

What does the radial head articulate with?

Answer 3

The capitulum of the humerus and the proximal ulna

Question 4

What do the articulations of the radial head allow for?

Answer 4

Flexion/extension and supination/pronation of the elbow

Question 5

How do radial head fractures typically occur?

Answer 5

Via indirect trauma, with axial loading of the forearm causing the radial head to be pushed against the capitulum of the humerus

Question 6

What arm position is most common in causing a radial head fracture?

Answer 6

Arm in extension and pronation

Question 7

What can be damaged in radial head fracutres?

Answer 7

Complex ligament structures

Question 8

What is the result of the potential for damage to complex ligament structures in radial head fractures?

Answer 8

This may need further clinical/imaging assessment

Question 9

How do radial head fractures often present?

Answer 9

With a history of falling on an outstretched hand followed by elbow pain. The patient may report variable degrees of swelling and bruising at the elbow

Question 10

What may be found on examination with radial head fractures?

Answer 10

• Tenderness on palpation over the lateral aspect of elbow and radial head
• Pain and crepitation on supination and pronation
• Elbow effusion
• Limited supination and pronation movements

Question 11

What other injuries are associated with a fall on an outstretched hand?

Answer 11

• Wrist ligament and bony injuries
• Radial head fractures and dislocations

Question 12

What is an Essex-Lopresti fracture?

Answer 12

A fracture of the radial head with disruption of the distal radio-ulnar joint

Question 13

What management will an Essex-Lopresti fracture always require?

Answer 13

Surgical intervention

Question 14

What investigations are done in patients presenting with suspected radial head fractures?

Answer 14

• Routine blood tests, including clotting screen and G&S
• Imaging

Question 15

What is recommended as initial imaging in radial head fractures?

Answer 15

Plain AP and lateral radiographs of the elbow, including imaging of joints above and below if their involvement is suspected

Question 16

What is the problem with the diagnosis of radial head fractures?

Answer 16

Radial head fractures can easily be missed on plain radiographs, and occassionally only elbow effusion may be seen

Question 17

What is ‘Sail sign’?

Answer 17

The term used for elbow effusions on a lateral projection

Question 18

What is Sail sign?

Answer 18

Elevation of the anterior fat pad

Question 19

Where might CT be useful in radial head fractures?

Answer 19

Useful in evaluating more complex injuries and degree of comminution

Question 20

When might MRI imaging be useful in radial head fracture?

Answer 20

Can be used to assess suspected association ligament injuries

Question 21

What are radial head fractures classified according to?

Answer 21

The degree of displacement and intra-articular involvement

Question 22

What classification is used for radial head fractures?

Answer 22

Mason classification

Question 23

What is a Mason type 1 fracture?

Answer 23

Non-displaced or minimally displaced (<2mm) radial head fracture

Question 24

What is a Mason type 2 fracture?

Answer 24

Partial articular fracture of the radial head with displacement >2mm or angulation

Question 25

What is a Mason type 3 fracture?

Answer 25

Comminuted fracture and displacement (a complete articular fracture) of the radial head

Question 26

What should be done in the immediate management of radial head fractures?

Answer 26

Ensure the patient is resuscitated appropriately and stabilised, prior to definitive management of the fracture. Ensure to provide adequate analgesia

Question 27

What is treatment of radial head fractures usually guided by?

Answer 27

The severity of fracture on imaging

Question 28

What should you check before deciding on treatment for radial head fractures?

Answer 28

• The presence of neurovascular compromise
• Any mechanical block of elbow motion (can the patient flex-extend and supinate-pronate?)

Question 29

How are Mason type 1 radial head fractures managed?

Answer 29

Treated non-operatively, with a short period of immobilisation with sling (less than 1 week) followed by early mobilisation

Question 30

How are Mason type 2 fractures managed?

Answer 30

If no mechanical block, then can be treated as per type 1 injury.

If mechanical block is present, then may need surgery, typically an open reduction internal fixation

Question 31

How are Mason type 3 radial head fractures managed?

Answer 31

Will nearly always warrant surgical intervention, either open reduction internal fixation or radial head excision and replacement

Question 32

What is the prognosis following a radial head fracture?

Answer 32

Patients can expect a good prognosis after radial head fracture, however secondary osteoarthritic changes may be encountered later in life in those who involve articular surfaces