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Elbow Fracture (Radial Head) – Treatment and Complications

What is a radial head fracture (elbow fracture)?

The radius bone extends from the elbow to the wrist, on the lateral side or the ‘outside’. The top of the radial bone is the radial head, located just below the elbow. Together with the upper arm bone or the humerus, the radial head makes up the outer half of the elbow joint.

The radial head bone is susceptible to fractures. A Mason classification is used to classify radial head fractures for assessing further treatment options:

Type I – Small marginal or non-displaced radial head elbow fractures
Type II – Partial articular fractures with displacement greater than 2mm
Type III – Fractures involving the entire radial head:
Type IIIa – With head completely displaced from the shaft
Type IIIb – Articular fracture involving the entire head; consists of more than two large fractures
Type IIIc – Fracture with an impacted and tilted articular segment
Type IV – A radial head fracture with dislocation of the elbow joint

What causes an elbow disorder?

Radial head fracture is the most common elbow joint fracture in adults (it is radial neck fracture in children). Its most common cause is a fall on an outstretched hand. It is instinctive to try and break a fall using hands; however, the force of the fall travels up the forearm bones and can dislocate the elbow, while breaking the radius head bone of the forearm.

What one needs to know about symptoms or signs?

  • Pain on the side of the elbow
  • Swelling of the elbow joint
  • Difficulty in straightening or bending the elbow; difficulty in turning the forearm

Which specialist should be consulted in case of an elbow fracture?

A radial head fracture requires immediate medial help at the hospital emergency room. An orthopaedic surgeon treats broken bone injuries.

What are the screening tests and investigations done to confirm or rule out an elbow fracture?

Diagnosis of radial head elbow fracture is carried out in the following ways:

Physical exam – The doctor carefully examines the wound to look for any open fractures. The elbow joint is felt to check for any deformity, along with checking for stability in the wrist. Elbow fractures place the major nerves of the forearm in danger; the doctor checks for the neurovascular functioning of the forearm and hand.
Imaging tests – A confirmatory diagnosis is made through x-ray of the elbow joint, which can also show if there has been any bleeding into the joint. Sometimes, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be needed.

What treatment modalities are available for management of an elbow fracture?

The goal of treatment of a radial head fracture is restoration of mobility and function of the elbow. Treatment options include:
Reduction – Broken bone fragments of the radius head may be realigned in either of the following ways:
Closed reduction and casting – This method has been associated with high levels of stiffness, higher rate of non-union and mal-union, and unstable fractures. It is generally used to treat an isolated radial head fracture.
Open reduction with internal fixation – This procedure involves accessing the bone fragments, realigning and fixing or replacing the pieces internally. It is associated with long-term functionality.
Surgical treatment – Unstable radial head fractures require surgical intervention. Surgery is carried out if the fracture involves more than 33 per cent of the articular surface, is displaced more than 3 mm, or is angulated more than 30 degrees. Surgery is also the preferred option in case of open fractures and fractures that block mechanical movement.

What are the complications associated with an elbow fracture?

The most common problem with radial head fractures is elbow stiffness. Also, the fracture may fail to heal, causing persistent pain. Wear and tear over time can lead to development of arthritis in the joint.

What precautions or steps are necessary to stay healthy and happy during the treatment?

The overall outcome of a radial head fracture depends on the severity of the fracture, injury to the elbow and the treatment method. Generally, an elbow returns to its normal motion and function in three months’ time.

Pain and swelling can be contained through the application of ice packs to the injured area. Elevating the arm to the level of the heart can help reduce swelling. Over-the-counter pain relievers help deal with the pain associated with the fracture.

The sling or splint helps immobilize the elbow and aid the healing process. However, under the care of the doctor and a physical therapist, early motion in the shoulder, wrist and fingers is encouraged. The earlier a patient begins to use his/her elbow, better are the chances of improving the range of motion.

However, the health care provider must be contacted in case of any of the following:
Tight or painful feeling in the elbow
Tingling or numbness in the elbow
Swelling or open sore in the skin
Problem in bending the elbow or lifting things after the sling or splint is removed


Sources:
“Elbow Injuries and Fractures,” Patient.co.uk, http://www.patient.co.uk/doctor/Elbow-Injuries-and-Fractures.htm
“Mason classification,” Radiopaedia.org, http://radiopaedia.org/articles/mason-classification
“Radial Head Fractures of the Elbow,” American Academy of Orthopaedic Surgeons, AAOS, http://orthoinfo.aaos.org/topic.cfm?topic=A00073
“Radial head fracture – aftercare,” MedlinePlus, http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000561.htm
“Radial Head Fractures,” Medscape.com, http://emedicine.medscape.com/article/1240337-overview
“Radial head fracture,” Elbowdoc.co.uk, http://www.elbowdoc.co.uk/elbow-trauma/radial-head-fracture; Image courtesy of [stockimages] / FreeDigitalPhotos.net

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