Radial head fracture

Background

• Most common fractures of the elbow, approx 20% of elbow fractures
• Caused by FOOSH in pronation leading to radial head being driven into the capitellum

Associated injuries (are common)

• Capitellum fracture
• Olecranon fracture
• Coronoid fracture
• MCL injury
• Elbow dislocation
• DRUJ (distal radial ulnar joint) injury
• Interosseous membrane disruption
• Terrible triad (radial head fracture, capitellar fracture, elbow dislocation)

Clinical Features

• Pain in the lateral elbow, especially with pronation/supination of forearm
• Swelling laterally and tenderness of radial head

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Diagnosis

• Elbow X-ray
  • Fractures are often subtle
    • Look for abnormal fat pad
    • Look for radiocapitellar line disruption
    • Greenspan View X-Ray
      • If possible, lateral elbow is shot at 45 degrees to pick up subtle fractures

Management

• Sling immobilization in flexion, ice, elevation
• Nondisplaced fracture with no mobility restrictions: ortho follow up within 1wk
• Displaced fracture or mobility restrictions: ortho follow up within 24hr

Disposition

• Normally outpatient

See Also

• Elbow diagnoses
• Elbow Fracture (Main)
• Radial head fracture (peds)