Radial Head Fractures

Epidemiology

• Accounts for ~20–30% of elbow fractures

• Common in adults

• Peak: 30–50 years

Mechanism of Injury

• Axial load transmitted through the forearm

• Valgus force + compression at radiocapitellar joint

Associated Injuries (High-Yield)

• Lateral collateral ligament (LCL) injury

• Coronoid fracture

• Essex-Lopresti injury (DRUJ + interosseous membrane disruption)

• Elbow dislocation

Always assess forearm and wrist

Classification

Mason Classification radial head fractures

Type I

• Non-displaced or minimal displacement

Type II

• Displaced (>2 mm) or angulated

• May cause mechanical block

Type III

• Comminuted fracture

Type IV

• Radial head fracture + elbow dislocation

Clinical Presentation

• Lateral elbow pain

• Swelling

• Limited ROM

• Pain with forearm rotation

Physical Examination

• Tenderness over radial head

• Pain with pronation/supination

• Check:

  • Elbow stability

  • Wrist pain (Essex-Lopresti!)

Imaging

X-ray

• AP and lateral views

• Look for:

  • Displacement

  • Fat pad sign

CT Scan

• Better for:

  • Comminution

  • Surgical planning

Treatment

Nonoperative

Indications

• Mason Type I

• Type II without mechanical block

Management

• Early mobilisation

• Sling for comfort (short duration)

Avoid prolonged immobilisation

Operative Treatment

Indications

• Mechanical block to motion

• Displaced Type II

• Type III (comminuted)

• Associated instability

Surgical Options

ORIF (Open Reduction Internal Fixation)

• Preferred when fracture is reconstructable

Radial Head Arthroplasty

• Comminuted, unreconstructable fractures

• Important in elbow instability

Radial Head Excision

• Rarely used

• Only in:

  • Low-demand patients

  • No instability

Special Injury: Essex-Lopresti

Key Features

• Radial head fracture

• Interosseous membrane rupture

• DRUJ instability

Missed diagnosis = poor outcome

Complications

• Stiffness (most common)

• Nonunion

• Malunion

• Chronic instability

• Post-traumatic arthritis

Prognosis

• Good in Type I

• Variable in comminuted fractures

• Depends on associated injuries

Pits & Pearls

• Always examine the wrist (Essex-Lopresti)

• Early motion = key to good outcome

• Radial head = secondary stabiliser of elbow

• Arthroplasty better than excision in instability

Pitfalls

• Missing DRUJ injury

• Over-immobilisation → stiffness

• Excision in unstable elbow

• Underestimating comminution

Mini Decision Algorithm

Radial Head Fracture: ORIF vs Arthroplasty Decision Table