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Proximal Radius Fracture
From WikiSM
Contents
Other Names
- Radial Head Fracture
- Radial Neck Fracture
Background
- This page describes all proximal Radius fractures, including Radial Head and radial neck
History
Epidemiology
- Most common forearm/ elbow injury in adults, representing about 33% (need citation)
- Radial head fractures represent up to 4% of all fractures[1]
Pathophysiology
Mechanism
- Trauma almost universally
- Fall on outstretched hand (FOOSH) injury
- Elbow typically in extension or hyperextension, forearm pronated
- Force vector transmitted down Humerus, through condyles into radial head
Associated Injuries
- Radial Collateral Ligament Injury
- Most common co-occurring injury
- Ulnar Collateral Ligament Injury
- Essex Lopresti Fracture
- Olecranon Fracture
- Coronoid Fracture
- Scaphoid Fracture
- Terrible Triad of Elbow: Elbow Dislocation, Radial Head Fracture, Coronoid Fracture
Pathoanatomy
- Involved joints: Radiocapitallar, Humeroulnar Joint
- Bones: Proximal Radius
- Ligaments: Lateral Collateral Ligament Complex, Ulnar Collateral Ligament
Risk Factors
- Female > Male
Differential Diagnosis
Differential Diagnosis Elbow Pain
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Differential Diagnosis Forearm Pain
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
Clinical Features
- History
- Patient should describe mechanism
- Will report pain, swelling
- Inability to fully extend elbow
- Physical Exam: Physical Exam Elbow
- Tenderness along the radial head
- Diminished range of motion due to effusion or mechanical block from osseous fragment
- Special tests
- Elbow Valgus Stress Test: Test UCL
- Elbow Varus Stress Test: Test LCL (high incidence of injury)
- DRUJ Compression Test: Evaluate distally including interosseus membrane
Evaluation
Radiographs
- Standard Radiographs Elbow
- Typically sufficient to make the diagnosis
- Radiocapitellar View: oblique lateral allows better visualization of the radial head
- Findings
- Look for elbow effusion, Posterior Fat Pad Sign
CT
- Useful to better characterize fracture, especially complex or comminuted
Classification
Mason Classification of Radial Head Fractures
| Type | Description |
| Type I | Nondisplaced or minimally displaced (<2 mm), no mechanical block to rotation |
| Type II | Displaced >2 mm or angulated, possible mechanical block to forearm rotation |
| Type III | Comminuted and displaced, mechanical block to motion |
| Type IV | Radial head fracture with associated elbow dislocation |
Management
Radial Head Fractures
Nonoperative
- Indications: Mason Type I, minimally displaced with no mechanical symptoms
- Immobilization for a short period followed by early mobilization
Operative
- Indications[2]
- Mason Type II with mechanical block
- Mason Type III
- Complex injuries
- Procedure
- Fragment excision
- Radial head resection
- Radial head arthroplasty
- Nail reduction
Radial Neck Fractures
Nonoperative
- Mostly non displaced and managed conservatively
- Immobilization: Long Arm Cast
Operative
- Indications: Transverse fracture with fragment displacement
Rehab and Return to Play
Rehabilitation
- Depends on injury
- Mason type I can likely begin range of motion and therapy early at 2-4 weeks
Return to Play/ Work
Complications and Prognosis
- Radiocapitellar joint arthritis
- Fragment displacement
- Chronic pain
- Elbow stiffness/ loss of motion
- Decreased pronation/supination
See Also
External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Morey B. The Elbow and Its Disorders, 3rd ed, Saunders, Philadelphia 2000.
- ↑ https://www.orthobullets.com/trauma/1019/radial-head-fractures