Radial head and neck fractures in adults
- Mark Slabaugh, MD
Mark Slabaugh, MD
- Associate Professor of Surgery
- Uniformed Services University of Health Sciences
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Radial head and neck fractures occur frequently, most often following a fall onto an outstretched hand. Nondisplaced fractures can be managed by knowledgeable, primary care physicians; orthopedic referral is needed for more complex fractures.
The presentation, evaluation, and basic management of radial head and neck fractures are reviewed here. The management of pediatric elbow fractures and other upper extremity injuries is discussed separately. (See "Elbow anatomy and radiographic diagnosis of elbow fracture in children" and "Evaluation of elbow pain in adults" and "Distal radius fractures in adults".)
EPIDEMIOLOGY AND RISK FACTORS
Some studies describe a male predominance with a ratio of 2:1, but others describe equal distribution between genders [4,5]. On average, fractures in men occur seven years earlier than in women . Radial head fractures occur throughout adulthood; the mean age at the time of injury is approximately 45 years. Fractures of the radial neck occur most often in children and are much less common in adults.
The radial head and neck comprise the most proximal portion of the radius (figure 1 and figure 2 and figure 3). The radial head lies at the proximal end. It is disk-shaped with a flattened end that articulates with the capitellum of the humerus proximally. The radial head also articulates with the lesser sigmoid notch of the ulna medially. Just distal to the head but proximal to the tuberosity is the radial neck, which is narrower than the head and slightly concave.
- Conn, J, Wade, PA. Injuries of the elbow: A ten-year review. J Trauma 1961; 1:248.
- MASON ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 1954; 42:123.
- Morey B. The Elbow and Its Disorders, 3rd, Saunders, Philadelphia 2000.
- ARNER O, EKENGREN K, VON SCHREEB T. Fractures of the head and neck of the radius; a clinical and roentgenographic study of 310 cases. Acta Chir Scand 1957; 112:115.
- van Riet RP, Morrey BF, O'Driscoll SW, Van Glabbeek F. Associated injuries complicating radial head fractures: a demographic study. Clin Orthop Relat Res 2005; 441:351.
- Yamaguchi K, Sweet FA, Bindra R, et al. The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg Am 1997; 79:1653.
- JOHNSTON GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 1962; 31:51.
- McKee MD, Jupiter J. Trauma to the adult elbow and fractures of the distal humerus. In: Skeletal Trauma: Basic Science, Management, and Reconstructions, 3rd ed, Browner B, Jupiter J, Levine A, Trafton P (Eds), Saunders, Philadelphia 2002. p.1404.
- van Riet RP, Morrey BF. Documentation of associated injuries occurring with radial head fracture. Clin Orthop Relat Res 2008; 466:130.
- Itamura J, Roidis N, Mirzayan R, et al. Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg 2005; 14:421.
- Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am 1999; 81:1429.
- O'Dwyer H, O'Sullivan P, Fitzgerald D, et al. The fat pad sign following elbow trauma in adults: its usefulness and reliability in suspecting occult fracture. J Comput Assist Tomogr 2004; 28:562.
- Greenspan A, Norman A. The radial head, capitellum view: useful technique in elbow trauma. AJR Am J Roentgenol 1982; 138:1186.
- Weseley MS, Barenfeld PA, Eisenstein AL. Closed treatment of isolated radial head fractures. J Trauma 1983; 23:36.
- Liow RY, Cregan A, Nanda R, Montgomery RJ. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury 2002; 33:801.
- Unsworth-White J, Koka R, Churchill M, et al. The non-operative management of radial head fractures: a randomized trial of three treatments. Injury 1994; 25:165.
- Radin EL, Riseborough EJ. Fractures of the radial head. A review of eighty-eight cases and analysis of the indications for excision of the radial head and non-operative treatment. J Bone Joint Surg Am 1966; 48:1055.
- Dooley JF, Angus PD. The importance of elbow aspiration when treating radial head fractures. Arch Emerg Med 1991; 8:117.
- Holdsworth BJ, Clement DA, Rothwell PN. Fractures of the radial head--the benefit of aspiration: a prospective controlled trial. Injury 1987; 18:44.
- Mehta JA, Bain GI. Elbow dislocations in adults and children. Clin Sports Med 2004; 23:609.
- PARVIN RW. Closed reduction of common shoulder and elbow dislocations without anesthesia. AMA Arch Surg 1957; 75:972.
- Meyn MA Jr, Quigley TB. Reduction of posterior dislocation of the elbow by traction on the dangling arm. Clin Orthop Relat Res 1974; :106.
- Minford EJ, Beattie TF. Hanging arm method for reduction of dislocated elbow. J Emerg Med 1993; 11:161.
- Duckworth AD, Wickramasinghe NR, Clement ND, et al. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 2014; 96:1716.
- EPIDEMIOLOGY AND RISK FACTORS
- FUNCTIONAL ANATOMY
- MECHANISM OF INJURY
- CLINICAL PRESENTATION AND EXAMINATION
- RADIOGRAPHIC FINDINGS
- INDICATIONS FOR ORTHOPEDIC REFERRAL
- INITIAL MANAGEMENT
- Goals of care
- Basic treatment
- Limited joint motion
- PROGNOSIS AND COMPLICATIONS
- RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS