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Proximal Radius Fracture

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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

Pathoanatomy


Risk Factors

  • Female > Male

Differential Diagnosis

Differential Diagnosis Elbow Pain

Differential Diagnosis Forearm Pain


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

Evaluation

Nondisplaced radial head fracture with posterior fat pad sign

Radiographs

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


References


  1. Morey B. The Elbow and Its Disorders, 3rd ed, Saunders, Philadelphia 2000.
  2. https://www.orthobullets.com/trauma/1019/radial-head-fractures
Created by:
John Kiel on 4 July 2019 07:11:27
Authors:
Last edited:
17 August 2021 23:59:03
Categories:
Trauma | Elbow | Forearm | Upper Extremity | Fractures | Acute