Radial Head Fracture

The radius is one of the two long bones in the forearm, and the radial head is the top part of the radius bone that forms part of the elbow joint. A radial head fracture occurs when this part of the bone is broken or cracked, often due to trauma such as falling on an outstretched hand or a direct blow to the elbow. The radial head plays a crucial role in forearm rotation (turning your palm up or down) and elbow stability. Because of its location at the elbow joint, fractures here can affect elbow movement, strength, and function. Radial head fractures are the most common type of elbow fracture in adults.

These fractures often happen alongside other injuries such as:

• Ligament tears, especially of the lateral collateral ligament(LCL), which helps stabilize the outside of the elbow.
• Dislocationsof the elbow joint, where bones in the joint are forced out of their normal positions.
• Other fractures may occur in the upper limb, such as the scaphoid bonein the wrist, due to the force transmitted through the arm.

Radial head fractures are indeed a unique challenge in fracture management due to the bone’s poor blood supply, especially in comminuted (shattered) fractures. This can lead to necrosis (bone death) and resorption (bone loss), according to some studies. The radial head’s blood supply is particularly vulnerable to disruption during fracture, which can impair healing and lead to long-term complications like arthritis and elbow stiffness.

The elbow is a complex hinge joint that allows two main types of movements:

1. Bending and straightening the arm(flexion and extension).
2. Rotating the forearmso that the palm can face up or down — known as supination (palm up) and pronation (palm down).

This combination of movements makes the elbow essential for many everyday tasks such as lifting, throwing, turning doorknobs, or typing.

The elbow joint is formed by the interaction of three bones: the humerus, the ulna and the radius. The head of the radius is especially important for rotational movement. It acts like a pivot, allowing the radius to rotate over the ulna during supination and pronation of the forearm.

When the head of the radius is fractured, it can affect the function of the elbow, especially the rotational movement.

Radial head fractures are classified based on how much the bone fragments are displaced into three types:

• Nondisplaced fractures: The bone is broken but still stays in its normal anatomical position. These often heal well with conservative treatment such as immobilization and physical therapy.
• Partially displaced fractures: Part of the fractured bone has shifted away from its original position. This may require more careful treatment, sometimes including surgery, to realign the bone for proper healing.
• Comminuted fractures: The bone is broken into multiple pieces. These are more severe injuries and often require surgical intervention to restore the shape and function of the elbow.

Radial head fractures commonly occur due to indirect trauma rather than a direct hit. This means that the injury is usually caused by a force transmitted through the forearm rather than a blow directly to the elbow. The most frequent cause is falling onto an outstretched hand, especially when the hand is extended (straight) or slightly bent (flexed). The force travels up the arm, impacting the radial head at the elbow, which is the part of the radius bone near the elbow joint. Direct trauma or a direct blow to the elbow can fracture the radial head, but this is relatively rare.

The most common symptom of a radial head fracture is pain localized on the outer (lateral) side of the elbow. This pain starts immediately after the injury. At the same time, swelling occurs around the elbow, and the range of motion is limited. Movements like bending (flexion) and straightening (extension) of the elbow become difficult and painful.

Supination and pronation movements of the forearm are accompanied by significant pain. Sometimes the trauma also injures the ligaments around the elbow, leading to joint instability (the feeling that the elbow might “give out” or feels loose). If the injury extends down the forearm to the joint near the wrist, wrist pain can also occur.

A radial head fracture diagnosis involves a combination of patient medical history, a thorough clinical examination and imaging tests. Swelling and stiffness in the elbow joint, along with pain upon palpation, suggest a fracture. Plain X-rays are the initial imaging test that they help identify the presence, type (simple, displaced, or comminuted) and the extent of the fracture.  CT or MRI may be necessary for displaced or comminuted fractures to assess for associated injuries like ligament tears, dislocations or additional fractures in other parts of the upper limb. It is very important to conduct a thorough examination to reveal both the severity of the injury and any accompanying damage to ligaments or other bones. Knowing the exact injury pattern and severity helps decide the best treatment method — whether conservative (immobilization and physical therapy) or surgical intervention.

Depending on the type of radial head fracture, the preferred treatment method is selected. The treatment is divided into the conservative (non-surgical) and the surgical one. The conservative treatment is typically recommended for non-displaced fractures — meaning the broken pieces of bone have not moved out of place — and when there are no associated injuries like ligament tears or joint dislocations.

In this case, immobilization of the elbow with simple suspension or a splint is recommended. This lasts around 3 weeks and aims to allow the bone to heal naturally without movement that could worsen the injury. After the immobilization period, the patient begins a specialized physiotherapy program aimed at gently mobilizing the elbow joint to restore movement and strength. Keeping the elbow still for too long can cause stiffness and loss of motion, so early movement after the initial healing phase is important.

A radial head fracture that is classified as displaced (bone fragments have shifted from their normal anatomical position) requires surgical treatment to restore proper alignment and function. The procedure involves Open Reduction & Internal Fixation (ORIF) with special small screws that are typically used to hold the bone pieces together. After surgery, early mobilization (movement) of the elbow is encouraged to avoid stiffness and maintain joint flexibility.

In more complex or severely displaced fractures, ORIF with small plates and screws is necessary. Plates provide additional stability for fragments that cannot be fixed adequately with screws alone. One possible complication after this surgery is a small risk of elbow stiffness, due to scar tissue or prolonged immobilization.

When the radial head fracture is severely comminuted, it is often impossible to fix the fragments with screws or plates because the pieces are too small or unstable. In cases where internal fixation isn’t feasible due to comminution, radial head arthroplasty is performed. This procedure involves removing the damaged radial head and replacing it with a metal prosthesis (artificial radial head). Arthroplasty aims to restore elbow stability and function. Postoperative care includes intensive physical therapy to regain range of motion and strength. Most patients return to daily activities within 2 to 3 months after surgery.