[10] Radial Head Fractures Flashcards
What proportion of elbow fractures are radial head fractures?
1/3
Which age group has the highest incidence of radial head fractures?
Those between 20-60 years of age, with a slightly higher incidence in females
What does the radial head articulate with?
The capitulum of the humerus and the proximal ulna
What do the articulations of the radial head allow for?
Flexion/extension and supination/pronation of the elbow
How do radial head fractures typically occur?
Via indirect trauma, with axial loading of the forearm causing the radial head to be pushed against the capitulum of the humerus
What arm position is most common in causing a radial head fracture?
Arm in extension and pronation
What can be damaged in radial head fracutres?
Complex ligament structures
What is the result of the potential for damage to complex ligament structures in radial head fractures?
This may need further clinical/imaging assessment
How do radial head fractures often present?
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
What may be found on examination with radial head fractures?
- 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
What other injuries are associated with a fall on an outstretched hand?
- Wrist ligament and bony injuries
- Radial head fractures and dislocations
What is an Essex-Lopresti fracture?
A fracture of the radial head with disruption of the distal radio-ulnar joint
What management will an Essex-Lopresti fracture always require?
Surgical intervention
What investigations are done in patients presenting with suspected radial head fractures?
- Routine blood tests, including clotting screen and G&S
- Imaging
What is recommended as initial imaging in radial head fractures?
Plain AP and lateral radiographs of the elbow, including imaging of joints above and below if their involvement is suspected
What is the problem with the diagnosis of radial head fractures?
Radial head fractures can easily be missed on plain radiographs, and occassionally only elbow effusion may be seen
What is ‘Sail sign’?
The term used for elbow effusions on a lateral projection
What is Sail sign?
Elevation of the anterior fat pad
Where might CT be useful in radial head fractures?
Useful in evaluating more complex injuries and degree of comminution
When might MRI imaging be useful in radial head fracture?
Can be used to assess suspected association ligament injuries
What are radial head fractures classified according to?
The degree of displacement and intra-articular involvement
What classification is used for radial head fractures?
Mason classification
What is a Mason type 1 fracture?
Non-displaced or minimally displaced (<2mm) radial head fracture
What is a Mason type 2 fracture?
Partial articular fracture of the radial head with displacement >2mm or angulation
What is a Mason type 3 fracture?
Comminuted fracture and displacement (a complete articular fracture) of the radial head
What should be done in the immediate management of radial head fractures?
Ensure the patient is resuscitated appropriately and stabilised, prior to definitive management of the fracture. Ensure to provide adequate analgesia
What is treatment of radial head fractures usually guided by?
The severity of fracture on imaging
What should you check before deciding on treatment for radial head fractures?
- The presence of neurovascular compromise
- Any mechanical block of elbow motion (can the patient flex-extend and supinate-pronate?)
How are Mason type 1 radial head fractures managed?
Treated non-operatively, with a short period of immobilisation with sling (less than 1 week) followed by early mobilisation
How are Mason type 2 fractures managed?
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
How are Mason type 3 radial head fractures managed?
Will nearly always warrant surgical intervention, either open reduction internal fixation or radial head excision and replacement
What is the prognosis following a radial head fracture?
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
