Radial Head #

Question 1

Pathophys of radial head #

Answer 1

• Radial head articulates with capitulum of humerus and proximal ulna
• Allows for flexion and extension, supination and pronation
• Axial loading of forearm can cause radial head to be pushed against capitulum - extension and pronated usually

Question 2

Clinical features of radial head #

Answer 2

• FOOSH
• Elbow pain
• Swelling or bruising at elbow
• Tenderness over lateral aspect elbow and radial head

Question 3

What is a radial head injury that will always need surgery?

Answer 3

• Essex Lopresti fracture
• Fracture of radial head with disruption to the distal radioulnar joint
• = always need surgery

Question 4

Sign on imaging of radial head #

Answer 4

• Sail sign
• = elbow effusion so elevation of the anterior fat pad is seen

Question 5

X-rays for radial head #

Answer 5

• AP and lateral
• Joint above and below
• CT imaging if complex
• MRI if suspect ligament injury

Question 6

Classification system of radial head #

Answer 6

• Mason classfication

Question 7

Mason classification

Answer 7

• Type 1 - non-displaced or minimally displaced # (<2mm)
• Type 2 - partial articular # with displacement >2mm or angulation
• Type 3 - comminuted # and displacement - complete articular #

Question 8

Management of radial head # - general

Answer 8

• A-E assessment
• Check NV status
• Adequate analgesia

Question 9

Management radia head # mason type 1

Answer 9

• Non-op
• Short period immbolisation with sling (<1 week)
• Followed by early mobilisation

Question 10

Management Mason type 2 #

Answer 10

• If no mechanical block to elbow motion then same as type 1
• If mechanical block, may need surgery - typically ORIF

Question 11

Management Mason type 3

Answer 11

• Always surgery
• Either ORIF or radial head excision and replacement - esp if highly comminuted