Radial head fracture: symptoms, treatment methods

Anatomy of a radial head fracture

How does the elbow joint work? The radius articulates with the humerus and proximal ulna. This joint allows flexion and extension of the forearm, as well as pronation (turning the palm down) and supination (turning the palm up) of the forearm.

The head of the radius is covered with articular cartilage. This ensures sliding of the articular surface in two planes, which is extremely important for the elbow joint. Thus, articular fractures with post-traumatic arthrosis can lead to a mechanical obstacle to movement.

The head is also an important stabilizer of the elbow joint.

A fracture of the radial head, in addition to severe pain, is characterized by:

• significant decrease in elbow joint mobility, including passive and rotational movements,
• hemarthrosis,
• deformations of the outer surface of the elbow joint.

If a fracture of the head of the radial bone of the elbow joint is suspected, it is necessary to exclude the possibility of fracture-dislocation of the head of the radial bone, accompanied by a violation of the interosseous membrane. Therefore, if a fracture is suspected, adjacent joints should also be examined.

Most radial head fractures are isolated, but are sometimes accompanied by the following injuries:

• fracture of the coronoid process of the ulna
• rupture of the collateral ligament of the elbow joint
• interosseous membrane rupture
• Fracture-dislocation Goliazzi

Such an injury, which is also accompanied by a fracture of the head of the humerus, can occur with damage to the medial collateral ligaments and a fracture of the ulna bones with their shortening.

Arthroplasty

Similar effects are often carried out at the joints of the ends of bones. They represent the modeling of the joint to natural forms. If the patient complies with all the requirements of the rehabilitation medicine doctor, then the probability of a positive outcome is almost 100%.

The result of the operation on x-ray.

Indications are fibrous and bone ankylosis. With this deviation, the joint partially or completely loses mobility due to pathological changes. The causes of destruction are often arthritis, trauma, and arthrosis. With multiple fragmentations of the elements included in the connection, reconstruction becomes impossible. In this case, the fragments are removed, and the missing part is filled with artificial or the patient’s own tissues.

The elbow joint is able to move normally and function only if all its components have natural sizes and shapes. The technique is aimed at performing precisely this task. Today they produce ready-made plates that cover the surface of the affected joint. They are made from medical alloys or polymers. Special pastes and mixtures are also used to coat the compound. These products penetrate into the pores and gaps and harden there.

Diagnosis of radius fractures

Diagnosis of an elbow injury begins with interviewing the patient. The doctor must find out what the mechanism of injury was. Assess whether there are visible deformities, swelling, crepitus of bone fragments (crunching), subcutaneous hemorrhage (if the fracture is 2 or more days old), i.e. symptoms characteristic of a fracture.

In almost all cases of injury to the elbow joint, radiography is performed. As a rule, in the frontal and lateral projections, although in the oblique projection the head of the radial bone is very well visualized. If the injury was minor and on radiographs we see the normal location of the head of the radial bone, then the diagnosis of a fracture is questioned.

Radial head fractures can often be nondisplaced and therefore easily missed on plain radiographs. Even if a fracture is not visible on an x-ray, this does not mean that it does not exist. After 7 days, control radiographs must be taken to rule out a fracture. It is during this time that resorption of the fracture site occurs and can be clearly seen in the photographs.

Intra-articular fractures are necessarily accompanied by hemorrhage into the joint, which can be determined by ultrasound.

Computed tomography (CT) and magnetic resonance imaging (MRI) are used in the diagnosis of complex radial head fractures and for preoperative and postoperative management.

First aid

To provide first aid to the victim, you need to call an ambulance, then:

• give any painkiller;
• cover the open wound with a dry sterile bandage;
• stop the bleeding using a tourniquet, which is applied above the damaged area (if the bleeding is pulsating and the blood is bright scarlet) or under the wound (if the blood is dark red, it flows out of the wound evenly);
• loosen the tourniquet after an hour, a maximum of one and a half (you must remember the time of application of the tourniquet and provide information to emergency doctors).

Classification of radial head fractures

Historically, radial head fractures have been delineated according to the Mason classification, which distinguishes three types of injury:

1. Marginal fracture (without displacement or movement of fragments).

2. Marginal fracture (with displacement and movement of fragments).

3. Multicomminuted (in which the entire head of the radial bones is involved in the process).

(A fourth type was added to designate a fracture of the head with dislocation.) 4. Fracture accompanied by dislocation of the bones of the forearm.

There is also the Essex-Lopresti fracture, described in 1951. It is characterized by a comminuted fracture of the head of the radius, rupture of the distal radioulnar joint and dislocation of the head of the ulna towards the wrist.

And the so-called terrible triad of the elbow (dislocation of the bones of the forearm, fracture of the coronoid process and fracture of the head of the radius).

As a rule, only the first type of fractures does not require surgical intervention.

Transposition

It is performed for carpal tunnel syndrome. The disease develops due to increased pressure on the nerve passing through the elbow joint. It often occurs after bruises and is felt almost instantly: pain radiates to the forearm and hand, numbness appears on the inside of the limb and on the fingers. The pain intensifies when bending the elbow.

Pathology is diagnosed by palpation - a specialist finds pain points and determines the location of the damage. To confirm, electromyography and electroneuromyography can be performed, which examines the rate of arrival of nerve impulses. With carpal tunnel syndrome, the transmission rate is significantly reduced.

Treatment of the disease is permitted conservatively. In many cases, it is enough for the patient to exclude movements that cause him pain. If this is difficult, then it is possible to apply a special splint. If this method does not help, then transposition is performed.

This procedure involves moving the nerve to the front of the junction. This will avoid tension on the nerve and pain. To perform this, an incision is made in the area of ​​the epicondyle, the nerve is removed from the articular canal and laid along the front side of the joint. Such operations are performed extremely rarely and only in situations where it is impossible to eliminate the disease by non-traumatic methods.

Treatment of radial head fractures

The main goals of therapy for this injury include:

• restoration of the possibility of rotational movement,
• restoration of the entire range of motion of the forearms and elbows,
• carrying out prevention of the possibility of early occurrence of arthrosis of the elbow joints.

Treatment tactics are based on the degree of displacement, the size of the fragments and the presence of an intra-articular component in fractures of the radial head. And it depends on the type of classification above.

Fractures of the head of the elbow without displacement are treated conservatively. For this type of treatment, immobilization is used with plaster, a plastic polymer bandage and a rigid orthosis.

Immobilization is carried out for a period of no more than 3 weeks in the position of bending the arm at the elbow joint at an angle of 100-110 degrees and supination (turning the palm upward) of the forearm at an angle of 45 degrees!!! The elbow joint is very “capricious” in relation to the duration of immobilization. So, according to research and personal experience, I assure you that it is catastrophically difficult to develop the elbow joint to full range of motion after being in a cast for more than 3 weeks.

After three weeks, the plaster or polymer bandage is cut off or replaced with a hinged piece to begin developing movements in the elbow joint.

Surgical treatment of radial head fractures is used when:

• an open fracture is observed,
• conservative treatment does not produce results,
• a segmental fracture is observed,
• there is a compound fracture,
• there is a fracture with the inability to move the elbow joint as a result of displacement,
• when Goleazzi is damaged.

Fixation of fragments or endoprosthetics of the radial head is usually carried out through the posterolateral approach (Kocher), between the extensor carpi ulnaris muscle and the anconeus muscle. In the position of pronation of the forearm with abduction and protection of the radial nerve during surgery.

This type of treatment uses:

• endoprosthetics,
• bone osteosynthesis,
• resection of the head of the radial bones,
• installation of Kirschner spokes.

Removal of the head of the radial bone occurs in severe fractures with the presence of many splinters and fragments. In this case, patients experience valgus instability and pain. However, this method is widely used in Russia due to the lack of experience in endoprosthesis replacement of the radial head by surgeons or, more often, due to the lack of endoprosthesis in a medical institution. Not many patients have the financial ability to purchase a prosthesis at their own expense.

General information

A radial head fracture is an intra-articular injury that can result from:

• falling on a straightened arm, elbow or hand;
• a strong blow to the elbow.

Sports injuries are usually caused by a fall on a straight arm. In everyday life, older women are often injured when they fall on their elbow. In this case, a closed fracture of the head of the left radial bone is diagnosed more often than damage to the bones of the right hand.

In patients with osteoporosis (a chronic disease characterized by a decrease in bone density), inflammatory diseases and oncological pathologies of the bones, and a severe lack of calcium and protein in the body, injury can occur even with a light force on the elbow. Such a fracture is pathological, and its root cause is a somatic disease.

Damage to the beam head can also occur in a traffic accident, as a result of an industrial accident, or after a fall from a height. In such situations, the injury is often combined with dislocations, bruises, and other fractures.

Rehabilitation after a fracture

Immediately after the pain in the fracture area has decreased, doctors allow moderate movements in the elbow joint. Athletes are strictly prohibited from carrying out rehabilitation using excessive loads when developing a joint in order to avoid re-injury. Only after consolidation of the radial head fracture can development activities with moderate load be carried out.

Don't self-medicate!

Only a doctor can determine the diagnosis and prescribe the correct treatment. If you have any questions, you can call or ask a question by email.

Endoprosthetics

This technique is one of the most complex and at the same time effective. With its help, you can restore your limbs to their former mobility. Its essence is to replace a damaged part of the skeleton that cannot be restored or treated with an endoprosthesis made of neutral materials. Indications for this procedure are:

• Arthrosis and arthritis;
• Comminuted fractures;
• Ankylosing spondylitis;
• Dystrophic and atrophic processes;
• Dysplasia;
• False joint.

The prosthesis is implanted through an incision on the extensor side, fixed with cement or cementless and sutured. The rehabilitation period is 2-3 months, but movements of the replaced part are allowed within a month after suturing.