Radial Head Fractures

Abstract

Radial head fractures are common injuries of the elbow and make up roughly 33% of all elbow fractures. These fractures typically occur when an axial load is applied to the forearm, causing the radial head to impact the capitellum of the humerus. The severity of these injuries ranges from minimally displaced fractures needing minimal treatment to those with major displacement or comminution, requiring surgical fixation, excision, or replacement.

What position of the arm during a fall causes a radial fracture?	Elbow fully extended and forearm pronated
What is the terrible triad of the elbow?	Elbow dislocation, radial head fracture, and coronoid fracture
What is an Essex-Lopresti injury ?	Radial head fracture, interosseous membrane disruption, DRUJ injury
Most common classification for radial head fractures?	Mason classification  Type I: Nondisplaced  Type II: Displaced (>2 mm) with rotation block  Type III: Comminuted and displaced  Type IV: Elbow dislocation + radial head fracture
How to assess a block to forearm rotation in the setting of a radial head fracture?	Aspirate elbow hematoma and inject lidocaine (reduces pain associated with the fracture)
What is important if managing a nondisplaced radial head nonoperatively?	Early ROM (after few days in a sling) to avoid elbow stiffness
Surgical treatment options for radial head fractures?	ORIF, partial excision, full excision, radial head replacement
Fragments under what size should be excised?	Fragments<25% radial head articular surface should be excised
How to decide between fragment excision vs. radial head replacement?	Replace the radial head if more than three fragments need to be excised
Which nerve is at risk during a surgical approach to the radial head?	PIN —Avoid damaging this nerve with pronation of the forearm
What are safe zones for ORIF of radial head?	90° arc on the radial head that is in line with the radial styloid to the bicipital tuberosity