A radial head fracture is one of the most common types of elbow fracture that happens in adults ages 30 and up. This type of injury is most often caused by a fall onto an outstretched hand. Radial head fractures also occur in two groups of patients, which are elder women as a result of osteoporosis or young men as a result of trauma. They can also occur in all other groups of patients, although not as much as the others mentioned earlier. The radial head is shaped like a round disc and is important in the movements of the elbow. Also, the radial head moves both in flexion and extension (which helps bend) of the elbow joint, as well as the rotation of the forearm. Therefore, injury to the radial head can affect all movements at the elbow.
Furthermore, such fractures can be classified into three types based on their severity, such as:
- Type 1 – These are small fractures or cracks which may not even be visible in X-rays. The bone remains intact, and no displacement occurs.
- Type 2 – This may involve a slight displacement and a larger part of the bone may have been damaged.
- Type 3 – The bone is broken into multiple pieces and is largely displaced. Such injuries are serious and are accompanied by damage to the soft tissues as well as ligaments.
Causes & Symptoms
Radial head fractures typically occur with a fall on an outstretched hand with the forearm and hand facing down (pronation), leading to axial load across the elbow. 30% of radial head injuries have other associated injuries which can include the following:
- Elbow dislocation – An elbow dislocation occurs when any of the three bones in the elbow joint become separated or knocked out of their regular positions. Dislocation can be very painful, causing the elbow to become unstable and sometimes unable to move. Dislocation damages the ligaments of the elbow and can also damage the surrounding muscles, nerves, and tendons.
- Medial and lateral collateral ligament (MCL/LCL) injuries – Injury to either ligament can be caused by sudden twisting or blows to the knee. These injuries usually occur in contact sports, such as football and soccer, or in sports that involve rotation of the knee, such as skiing and ice skating.
- Coronoid fractures – The coronoid process is a triangular projection on the third olecranon bone. Fractures of the coronoid process are fairly uncommon and occur in a small percentage of patients with dislocations. These fractures occur as a result of an injury involving a postero-lateral or posterior elbow dislocation, a radial head fracture, and a coronoid process fracture.
- Carpal (wrist) fractures – A carpal fracture is a break to one of the small bones in the wrist. It is usually caused by direct trauma or a fall on an outstretched hand.
If your radial head of the elbow shows any of the following signs you may have a radial head fracture or another injury that needs medical attention:
- Swelling of your elbow or in the area immediately above or below your elbow.
- Deformity of your elbow, or the areas near your elbow.
- Discoloration, such as bruising or redness of your elbow.
- Difficulty moving your elbow through its full range of motion.
- Numbness, decreased sensation, or a cool sensation of your forearm, hand, or fingers.
- A cut, or open wound, on the elbow after a traumatic injury.
- Severe pain after an elbow injury.
- A “tight sensation” in the area of your elbow or forearm.
Who gets Radial Head Fracture?
There are a number of ways that radial head fractures can develop, and some people are at higher risk of getting the condition than others. Therefore, here are some additional risk factors for radial head fractures:
- Age – People ages 30 and older are at an increased risk of developing radial head fractures. The risk accelerates even more after age 40 due to general wear and tear.
- Direct trauma to the elbow – Such as colliding with another player or falling onto the elbow.
- Occupational laborers – Working in occupations that require climbing or machine operating can increase the risk of fracturing the radial head bone due to chances of falling and/or twisting movements.
How does it affect you? How serious is it?
If there are small fragments of bone that prevent normal elbow movement or have the potential to cause long-term problems with the elbow, they may need to be surgically removed. If fragments are large and far out of place, surgery may include the use of screws, or a plate and screws to hold the bones together.
Surgery is generally required to fix or remove pieces of broken bone and repair soft-tissue damage. When damage is severe, the entire radial head may need to be removed. In some cases, an artificial radial head may be put in place to improve long-term function. With any surgery, there are some risks, and these vary from person to person. Complications are usually minor, treatable, and unlikely to affect your final outcome.
Recommended Treatment & Rehabilitation
To successfully diagnose a fractured radial head, your doctor will first carefully examine the injured area of tenderness, redness, and swelling. One or more of the following imaging techniques may also be used to get clear pictures of the fractured bone and to check for damage to muscles or blood vessels:
- X-ray – The main tool used for diagnosing a fractured bone is an X-ray. An X-ray may help determine whether bones in the arm are either displaced or healing in the proper position.
- Magnetic Resonance Imaging (MRI) – Some fractures do not appear on an X-ray until a few weeks after the bone begins to feel pain. An MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
- Computed tomography (CT) scan – A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images, both horizontally and vertically, of the body.
Following a radial head fracture, a physiotherapist will design an individualized treatment program to help improve your elbow movement and strength, ease swelling, and restore the use of your arm for daily living and athletic activities. Therefore, while your bone heals, your arm will be in a cast or a sling to keep it still and allow healing. This is also the case if you have had surgery. During the recovery process, it is important to prevent as much stiffness, weakness, or swelling as possible.
Depending on the amount of activity that is allowed by your physician for your type of fracture or surgery, your physiotherapist will prescribe exercises to keep your shoulder, wrist, and hand moving while you are in the cast or sling. Your therapist will help you stay as independent as possible by teaching you how to perform your daily activities while wearing a cast or a sling.
When your cast or sling is removed, your elbow will most likely be stiff and your arm will be weak, especially if you have had surgery. Therefore, he or she will examine your elbow and select treatments based on your particular physical problems, goals, level of physical activity, and general health.
Your therapist may prescribe treatments to help you:
- Reduce pain and swelling – Your therapist may use different types of treatments and electrothermal modalities, such as specialized massage, electrical stimulation, and cold packs to reduce pain and swelling.
- Improve your ability to move – Your physiotherapist will choose specific activities and treatments to help restore normal movement in the elbow and arm. These might begin with passive motions that your therapist performs for you to gently move your elbow joint, and progress to active exercises and stretches that you do yourself.
- Increase your flexibility – Your therapist may gently apply hands-on treatment to enable your joints and muscles to move more freely with less pain. These techniques can include stretches and therapeutic massage techniques.
- Increase your strength – If your physiotherapist finds any weakness in your arm or hand muscles, he / she will choose, and teach you, the best exercises and equipment to steadily restore your strength and agility. You might use equipment, such as therapy bands, therapy putty, and hand weights to help strengthen your affected arm.
- Improve your endurance – Restoring your arm’s endurance is very important after an injury. Your therapist will develop a program of activities to help you regain the endurance you had before the injury, so you can return to doing the things that you like to do.
- Return to your activities – Your therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals.
Elbow stretching is also an important part of the healing process. Stretching the elbow is important in both healing and prevention, and these exercises may be repeated at home multiple times a day in order to ensure mobility of the elbow. The following below are some of these range of motion exercises:
First, stand with your arm at your side. Then, actively bend your elbow up as far as possible, then grasp your forearm or wrist with your other hand and gently add overpressure. Hold the bent position of your elbow for 5-10 seconds, and then release the stretch by straightening your elbow. Repeat this exercise 10 times a day.
Sit in a chair with your elbow resting on a table. You may want to rest your upper arm on a pillow or folded towel for comfort. Next, straighten your elbow out all the way, and then apply pressure to your forearm or wrist to add more pressure to the stretch. Straighten your elbow out as far as you can without pressure and hold the stretch for 5-10 seconds. Release the stretch and allow your elbow to bend a bit. Repeat this exercise for 2 sets of 10 repetitions a day.
Begin by standing or sitting with your arm at your side and your elbow bent about 90 degrees. Next, keep your elbow at your side and turn your wrist and hand over so your palm faces up. To add more pressure to the stretch, use your opposite hand and reach underneath the forearm of your supinated arm. Grab your wrist and gently add pressure by turning your hand further into supination. When a stretch is felt, hold the position for 5-10 seconds. Repeat this elbow supination exercise with 2 sets of 10 repetitions a day.
Stand or sit with your elbow bent at a 90-degree angle and tucked in at your side. Turn your hand and wrist over as far as possible, then reach your other hand over the top of your forearm. Then, grab your wrist, and turn your arm further into a pronated position. Finally, hold the position with pressure for 5-10 seconds, and then release the stretch. Repeat this stretch with 2 sets of 10 repetitions a day.
Alternative & Homeopathic Treatment
The following homeopathic treatments are to help ease discomfort and encourage healing after being treated for a fractured radial head:
Rest your fractured elbow. It is recommended to not repeat the action that caused your injury and rest your affected area before continuing with lighter activities.
Ice and heat application
Putting ice on your injured joint helps reduce inflammation and pain. Use a cold pack for 15-20 minutes at a time. For the first day or two, try to do this every couple of hours during the day. After 2 or 3 days, when the pain and inflammation have improved, hot packs or a heating pad may help relax tightened and sore muscles. Limit heat applications to 20 minutes at a time.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Over-the-counter medications, such as ibuprofen, naproxen, or acetaminophen, can all help relieve pain due to the injury.