Radial head fracture

Question 1

Articulations

Answer 1

At the elbow, the radial head articulates with the capitulum of the humerus and the proximal ulna

Question 2

Mechanism of injury

Answer 2

Axial loading causing the radial head to be pushed against the capitulum - FOOSH

Question 3

Clinical Features

Answer 3

Elbow pain and possible effusion

Swelling and bruising of elbow

Tenderness on palpation over the lateral aspect of elbow and radial head

Crepitation on supination and pronation

Question 4

Investigations

Answer 4

Routine blood tests, including a clotting screen and a Group and Save

Xray - AP and lateral

CT - more complex injuries and degree of comminution

MRI imaging - suspected ligament injuries

Question 5

Sail sign

Answer 5

elbow effusion

Question 6

Classification of Radial Head Fractures

Answer 6

Mason Type 1 – Non-displaced or minimally displaced fracture (<2mm)

Mason Type 2 – Partial articular fracture with displacement >2mm or angulation

Mason Type 3 – Comminuted fracture and displacement (a complete articular fracture)

Question 7

Management

Answer 7

ATLS
Analgesia

Mason type 1 injuries – short period of immobilization with sling (less than 1 week) followed by early mobilisation

Mason Type 2 injuries – if no mechanical block then can be treated as per a type 1 injury
- mechanical block - may need surgery ORIF

Mason Type 3 injuries – surgical intervention

• ORIF
• radial head excision
• replacement (especially in highly comminuted fractures)

Question 8

Complications

Answer 8

OA

Question 9

Essex-Lopresti fracture

Answer 9

fracture of the radial head with disruption of the distal radio-ulnar joint, and will always require surgical intervention