![]() ![]() Radial head fractures are known to present in combination with MCL ruptures and coronoid process fractures, a constellation known as the “terrible triad.” That may be because men usually have a high-energy mechanism of injury such as a fall from height or sports injury, whereas women, who tend to have lower-energy injuries, sustain the fracture due to inherent bone fragility.Īssociated injuries, which should be ruled out when a radial head fracture is suspected or confirmed, include fractures of the capitellum, fractures of the distal radius, dislocation of the distal radio-ulnar joint (the so-called Essex-Lopresti fracture), rupture of the medial collateral ligament (MCL) causing valgus instability, rupture of the triceps tendon, and elbow dislocation. Men who sustain radial head fractures tend to be younger than women with the same fracture. One-third of all elbow fractures involve the radial head. (This is usually reserved for patients with persistent pain after a period of immobilization.)Īlthough radial head fractures are not typically associated with osteoporosis, it may be prudent to assess bone density in middle-aged women who present with radial head fracture. MRI may be used to assess for possible osteochondral injuries of either the radial head itself or, more commonly, of the capitellum. Additionally, a positive fat pad sign on a lateral view indicates fluid in the joint, which in the acute setting is usually blood suggestive of a fracture (Figure 2).ĬT scanning may be used for preoperative planning, especially in the case of fragment displacement or comminution. Oblique views with the forearm in neutral rotation, so-called Greenspan views, show the radiocapitellar articulation and may be useful in the case of a suspected fracture that is not visible on AP or lateral films. A fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint is called an "Essex-Lopresti fracture." The distal radio-ulnar joint should be assessed on the lateral film for dislocation. Radiographs must be obtained in the case of suspected elbow fracture standard anteroposterior (AP) and lateral films of the elbow and of the wrist usually suffice. ![]() Aspiration of the effusion may assist with diagnosis and provide pain relief, thereby allowing faster and more effective rehabilitation. Intra-articular bleeding from the fracture may produce a palpable effusion. There is typically localized tenderness over the radial head on palpation passive rotation of the forearm is also painful. Pain, effusion over the elbow, and limited range of motion at the elbow and forearm are common symptoms. Patients with an injury to the radial head typically present with a history of a fall on an outstretched hand, or, following higher energy trauma and elbow dislocation. In particular, loss of the radial head may cause wrist symptoms, as such loss may cause proximal migration of the radius with additional load now placed on the proximal ulna. The radial head also ultimately connects to the carpus, as it is the base on which the radius itself is supported. (The central axis of the radius is not perfectly cylindrical, and thus during pronation, the radius must be able to translate a bit as well). This ligament holds the radius as it rotates, but also allows for some translation as well. Just distal to the radial head lies the annular ligament, which holds the radius to the ulna. The radial head translates on the capitellum during elbow flexion-extension, and pivots on the capitellum during supination-pronation. The radial head is concave, matching the convex surface of the capitellum of the humerus (Figure 2). The radial head articulates with both the capitellum of the humerus and the ulna. The impact from the fall drives the radius proximally into the humerus, causing an injury at the elbow. Perhaps counter-intuitively, fractures of the radial head (which is part of the elbow) typically occur after a fall on an outstretched hand. Radial head fractures are the most common type of elbow fractures in adults. ![]()
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