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<article id="post-18164" class="post-18164 post type-post status-publish format-standard hentry category-elbow category-joints tag-elbow tag-hand tag-humerus tag-muscles-tendons tag-spine tag-trauma-fractures tag-wrist" itemtype="https://schema.org/CreativeWork" itemscope> <div class="inside-article"> <header class="entry-header">   <span property="itemListElement" typeof="ListItem"><a property="item" typeof="WebPage" title="Go to Wheeless' Textbook of Orthopaedics." href="https://www.wheelessonline.com" class="home" data-wpel-link="internal"><span property="name">Home</span></a><meta property="position" content="1"></span> » <span property="itemListElement" typeof="ListItem"><a property="item" typeof="WebPage" title="Go to the Joints category archives." href="https://www.wheelessonline.com/./joints/" class="taxonomy category" data-wpel-link="internal"><span property="name">Joints</span></a><meta property="position" content="2"></span> » <span property="itemListElement" typeof="ListItem"><a property="item" typeof="WebPage" title="Go to the Elbow category archives." href="https://www.wheelessonline.com/./joints/elbow/" class="taxonomy category" data-wpel-link="internal"><span property="name">Elbow</span></a><meta property="position" content="3"></span> » <span property="itemListElement" typeof="ListItem"><span property="name" class="post post-post current-item">Radial Head Fracture</span><meta property="url" content="https://www.wheelessonline.com/joints/radial-head-frx/"><meta property="position" content="4"></span><hr style="border-top:1px dashed #ccc; width:75%"/> <h1 class="entry-title" itemprop="headline">Radial Head Fracture</h1> </header> <div class="entry-content" itemprop="text"> <div class="mh-row clearfix"> <div class="ooo-js" id="ooo-1704886929"></div> <script> /** * Open read more link */ document.addEventListener('DOMContentLoaded', function () { /** * Initial AJAX call */ function ooo_ajax() { var xhttp = new XMLHttpRequest(); var url = 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ooo_excerpt.className.indexOf( 'ooo-c-overview__excerpt--open' ) == -1 ) { ooo_excerpt.classList.add("ooo-c-overview__excerpt--open"); this.textContent = 'Close 禄'; } else { ooo_excerpt.className = "ooo-c-overview__excerpt"; this.textContent = 'Read more 禄'; } }); for (var i = 0; i < links.length; i++) { links.item(i).addEventListener("click", function( e ) { if ( ! confirm( "You are about to be taken to OrthOracle.com, do you want to proceed?") ) { e.preventDefault(); } }); } } }); </script> <div class="bodycopy"> <hr size="3" /> <p><a href="/wp-content/uploads/2020/07/rhd13.jpg" data-slb-active="1" data-slb-asset="1166986053" data-slb-internal="0" data-slb-group="18164" data-wpel-link="internal"><img decoding="async" src="/wp-content/uploads/2020/07/rhd13a.jpg" alt="" align="right" /></a>- See:<br /> - <a href="/12676" data-wpel-link="internal">Adult Radial Neck Frx</a> / <a href="/joints/elbow/pediatric-radial-head-frx/" data-wpel-link="internal">Pediatric Radial Head Frx</a></p> <p><strong>- Discussion:</strong><br /> - radial head frx is most common type of elbow fracture in adults;<br /> - frx of the radial head occurs primarily in adults, whereas fractures of the <a href="/joints/elbow/pediatric-radial-neck-fracture/" data-wpel-link="internal">radial neck</a> are more<br /> common in children;<br /> - frx of the radial head and neck of the radius generally results from a hard fall on an outstretched hand;<br /> - impact of fall drives head of radius axially onto capitulum of humerus;<br /> -聽high frequency of frx in聽anterolateral aspect of radial head occurs as a result of lack of subchondral bone<br /> under聽anterolaterl aspect of聽radial head;<br /> - because the anterolateral aspect of radial head does not articulate w/ sigmoid fossa, frx in the region are amenable to fixation<br /> w/ small screws;</p> <p>- <strong>associated injuries:</strong><br /> - <a href="/joints/elbow/capitelar-and-coronal-shear-frx/" data-wpel-link="internal">frx of the capitellum</a><br /> - <a href="/ortho/fractures_of_the_radius" data-wpel-link="internal">distal radius frx</a><br /> - dislocation of the <a href="/joints/radial-ulnar-joint-instability/" data-wpel-link="internal">distal RU joint</a> (<a href="/trauma-fractures/essex-lopresti-fracture/" data-wpel-link="internal">Essex Lopresti Fracture</a>)<br /> - valgus instability (<a href="/joints/elbow/medial-collateral-ligament-of-the-elbow/" data-wpel-link="internal">MCL</a> rupture)<br /> - probably more common than is reported;<br /> - indications for repair of the MCL will be determined based on stability of the elbow thru a functional range of motion;<br /> - rupture of the triceps tendon<br /> - <a href="/joints/elbow/radial-head-frx-elbow-dislocation/" data-wpel-link="internal">elbow dislocation</a>:<br /> - <strong>terrible triad</strong>: RHF + <a href="/posterolateral_elbow_instability" data-wpel-link="internal">LCL</a> / <a href="/joints/elbow/medial-collateral-ligament-of-the-elbow/" data-wpel-link="internal">MCL</a> + <a href="/joints/elbow/coronoid-process-fractures/" data-wpel-link="internal">coronoid process frx</a>;<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/27479736" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Risk of Subluxation or Dislocation after Operative Treatment of Terrible Triad Injuries<span class="wpel-icon wpel-image wpel-icon-6"></span></a>.<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24474322" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Terrible triad injuries of the elbow: does the coronoid always need to be fixed?<span class="wpel-icon wpel-image wpel-icon-6"></span></a><br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/24136807" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis<span class="wpel-icon wpel-image wpel-icon-6"></span></a><br /> - <a>Terrible Triad Injuries of the Elbow</a><br /> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28634742" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Outcomes of coronoid-first repair in terrible triad injuries of the elbow<span class="wpel-icon wpel-image wpel-icon-6"></span></a><br /> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30418065" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study<span class="wpel-icon wpel-image wpel-icon-6"></span></a><br /> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30656475" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Radial head replacement vs reconstruction for treatment of terrible triad injury of the elbow: a review and meta-analysis<span class="wpel-icon wpel-image wpel-icon-6"></span></a></p> <p>- <strong>Dx and Exam:</strong><br /> - dx of a radial head fracture may be difficult;<br /> - pain, effusion in the elbow, & tenderness on palpation directly over radial head are typical manifestations;<br /> - if frx is displaced, click or crepitus over radial head is detected w/ supination;<br /> - if elbow ROM is limited, then aspirate and inject several cc of lidocaine, and then re-examine;<br /> - check for blocks to flexion-extension as well as supination-pronation;<br /> - wrist tenderness with ROM is common;</p> <hr size="3" /> <p><strong>- <a href="/joints/elbow/radiology-of-the-elbow/" data-wpel-link="internal">Radiographic Features:</a></strong><br /> - AP & Lat (look for fat pad sign)<br /> - Radiocapitellar view: forearm in neutral rotation & the x-ray tube angle 45 d. cephalad<br /> - main disadvantage of this classification is that radiographs may underestimate the true degree of comminution;<br /> -聽references:<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/21924926" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Magnetic resonance imaging in radial head <span class="highlight">fractures</span>: most associated injuries are not clinically relevant<span class="wpel-icon wpel-image wpel-icon-6"></span></a>.<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/27379975" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">The cortical irregularity in transition zone of radial head and neck: a reliable radiographic sign of occult radial head fracture.<span class="wpel-icon wpel-image wpel-icon-6"></span></a></p> <p><a href="/wp-content/uploads/2020/07/raddh1.jpg" data-slb-active="1" data-slb-asset="410891568" data-slb-internal="0" data-slb-group="18164" data-wpel-link="internal"><img decoding="async" src="/wp-content/uploads/2020/07/raddh1a.jpg" alt="" align="middle" /></a> <a href="/wp-content/uploads/2020/07/raddh3.jpg" data-slb-active="1" data-slb-asset="1815641342" data-slb-internal="0" data-slb-group="18164" data-wpel-link="internal"><img decoding="async" src="/wp-content/uploads/2020/07/raddh3a.jpg" alt="" align="middle" /></a> <a href="/wp-content/uploads/2020/07/radh1.jpg" data-slb-active="1" data-slb-asset="233034012" data-slb-internal="0" data-slb-group="18164" data-wpel-link="internal"><img decoding="async" src="/wp-content/uploads/2020/07/radh1a.jpg" alt="" align="middle" /></a> <a href="/wp-content/uploads/2020/07/radh2.jpg" data-slb-active="1" data-slb-asset="203662200" data-slb-internal="0" data-slb-group="18164" data-wpel-link="internal"><img decoding="async" src="/wp-content/uploads/2020/07/radh2a.jpg" alt="" align="middle" /></a></p> <hr size="3" /> <p><strong>- Treatment:</strong> (based on Mason classification)<br /> - <a href="/joints/elbow/type-i-radial-head-fracture/" data-wpel-link="internal">type I</a><br /> - <a href="/joints/elbow/radial-head-frx-type-ii/" data-wpel-link="internal">type II</a><br /> - less than 30% of radial head;<br /> - more than 2 mm displacement<br /> - <a href="/ortho/12625" data-wpel-link="internal">ORIF of radial head fracture</a><br /> - <a href="/joints/type-iii-radial-head-fracture/" data-wpel-link="internal">type III</a><br /> - <a href="/joints/elbow/excision-of-radial-head/" data-wpel-link="internal">excision of radial head</a>:<br /> - <a href="/joints/elbow/radial-head-prosthetic-replacement/" data-wpel-link="internal">radial head implants</a>:<br /> - references:<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/7240293" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Treatment of displaced segmental radial-head fractures. Long-term follow-up.<span class="wpel-icon wpel-image wpel-icon-6"></span></a><br /> - <a href="/ortho/12676" data-wpel-link="internal">adult radial neck fracture</a><br /> - <a href="/joints/elbow/complex-elbow-dislocations/" data-wpel-link="internal">complex fractures</a><br /> - <a href="/joints/elbow/radial-head-frx-elbow-dislocation/" data-wpel-link="internal">radial head frx & elbow dislocation</a><br /> - <a href="/joints/elbow/radial-head-frx-elbow-dislocation/" data-wpel-link="internal">radial head frx & MCL instability</a><br /> - <a href="/trauma-fractures/essex-lopresti-fracture/" data-wpel-link="internal">Essex Lopresti Fracture</a><br /> - references:<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/1735237" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Radial head fractures and their effect on the distal radioulnar joint. A rationale for treatment<span class="wpel-icon wpel-image wpel-icon-6"></span></a>.<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8242935" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Radial head fracture. A potentially complex injury<span class="wpel-icon wpel-image wpel-icon-6"></span></a>.<br /> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/3409602" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited.<span class="wpel-icon wpel-image wpel-icon-6"></span></a></p> <p><strong>- Surgical Considerations:</strong><br /> - <a href="/joints/elbow/posterolateral-approach-to-elbow-kocher/" data-wpel-link="internal">posterolateral approach</a>: (<a href="/joints/elbow/posterolateral-approach-to-elbow-kocher/" data-wpel-link="internal">Kocher Approach</a>)<br /> - approach the fascial plane between the <a href="/bones/extensor-carpi-ulnaris/" data-wpel-link="internal">ECU</a> and <a href="/muscles-tendons/anconeus/" data-wpel-link="internal">anconeus muscle</a></p> <p>- direct <a href="/joints/elbow/lateral-approach-to-the-elbow-kaplan/" data-wpel-link="internal">lateral approach</a> is preferred by some surgeons because it spares the lateral ulnohumeral ligament;</p> <p>- <a href="/ortho/12625" data-wpel-link="internal">ORIF of radial head fracture</a> / <a href="/joints/elbow/safe-zone-for-radial-head-frx/" data-wpel-link="internal">safe zone for implant insertion</a></p> <p>- <a href="/joints/elbow/radial-head-prosthetic-replacement/" data-wpel-link="internal">radial head replacement</a>:</p> <hr size="3" /> <p><a href="http://www.ncbi.nlm.nih.gov/pubmed/7562154" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Fractures of the radial head treated by internal fixation: late results in 26 cases<span class="wpel-icon wpel-image wpel-icon-6"></span></a>.</p> <p><a href="http://www.ncbi.nlm.nih.gov/pubmed/2231124" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Internal fixation of proximal radial head fractures<span class="wpel-icon wpel-image wpel-icon-6"></span></a>.</p> <p><a href="http://www.ncbi.nlm.nih.gov/pubmed/14996884" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Uncomplicated Mason Type-II and III Fractures of the Radial Head and Neck in Adults. A Long-Term Follow-Up Study.<span class="wpel-icon wpel-image wpel-icon-6"></span></a></p> <p><a href="http://www.ncbi.nlm.nih.gov/pubmed/2766601" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Recurrent radial head subluxation treated with annular ligament reconstruction. A case report and follow-up study<span class="wpel-icon wpel-image wpel-icon-6"></span></a>.</p> <p><a href="http://www.ncbi.nlm.nih.gov/pubmed/12377912" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">Open Reduction and Internal Fixation of Fractures of the Radial Head.<span class="wpel-icon wpel-image wpel-icon-6"></span></a></p> <p><a title="Link to Article" href="http://www.ncbi.nlm.nih.gov/pubmed/22426693" data-wpel-link="external" target="_blank" rel="external noopener noreferrer" class="wpel-icon-right">In Brief: The Mason Classification of Radial Head Fractures<span class="wpel-icon wpel-image wpel-icon-6"></span></a></p> </div> <p> </p> <hr /> <p> </p> </div> </div> <footer class="entry-meta" aria-label="Entry meta"> <span class="cat-links"><span class="gp-icon icon-categories"><svg viewBox="0 0 512 512" aria-hidden="true" xmlns="http://www.w3.org/2000/svg" width="1em" height="1em"><path d="M0 112c0-26.51 21.49-48 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Wheeless, III, M.D.</strong><br /> Orthopaedic Specialists of North Carolina</p> <p> Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. 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