Radial Head Fracture

Injuries > Elbow & Forearm > Radial Head Fracture

What is a radial head fracture?

A radial head fracture is a condition characterized by a break in the head of one of the long bones of the forearm known as the radius (figure 1). The head of the radius is located just below the outer aspect of the elbow joint (figure 2).

The forearm comprises of two long bones known as the radius and the ulna which are situated beside each other (figure 1). The radius bone lies on the thumb side (outer aspect) of the forearm and forms joints with the upper arm bone (humerus) at the elbow, the ulna bone (both near the elbow and also, near the wrist) and several small bones at the wrist (figure 1). The radial head (or head of the radius) is a bony prominence at the top of the radius that forms a joint with the humerus and ulna and is situated just beneath the elbow joint on the outer aspect (figure 2).

During certain activities, such as a fall onto the outstretched hand or onto the outer elbow, stress is placed on the radius bone and the radial head. When this stress is traumatic and beyond what the bone can withstand a break in the radial head may occur. This condition is known as a radial head fracture.

A radial head fracture is one of the most common fractures around the elbow in athletes. They can, however, occur in patients of all ages and fitness levels. Often a fracture to the radial head occurs in combination with other injuries such as a sprain or dislocation of the wrist or elbow, or fractures to other bones such as the ulna, humerus or scaphoid.

Causes of a radial head fracture

A radial head fracture commonly occurs due to a traumatic weight bearing force, such as a fall onto an outstretched hand or outer elbow. This may occur with any fall, but is particularly common in sports such as skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving. A radial head fracture may also occur due to a collision to the outer elbow with a fast moving or stationary object (particularly if the forearm or hand is fixed).

Signs and symptoms of a radial head fracture

Patients with this condition typically experience a sudden onset of sharp, intense elbow or forearm pain at the time of injury. This often causes the patient to cradle the affected arm so as to protect the injury. Pain is usually felt on the front, back or outer aspect of elbow and forearm and can occasionally settle quickly leaving patients with an ache at the site of injury that is particularly prominent at night or first thing in the morning.

Patients with a radial head fracture may also experience swelling, bruising and pain on firmly touching the affected region of bone. Pain may also increase during certain movements of the elbow or wrist, when rotating the forearm, lifting or carrying or during weight-bearing activity (such as pushing) through the affected arm. Occasionally pins and needles or numbness may be present. In severe radial head fractures (with bony displacement), an obvious deformity may be detected.

Diagnosis of a radial head fracture

A thorough subjective and objective examination from a physiotherapist or doctor is essential to assist with diagnosis of a radial head fracture. An X-ray is recommended to confirm diagnosis. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of injury.

Treatment for a radial head fracture

Small undisplaced radial head fractures are usually treated with support in a sling for two to three weeks and physiotherapy to restore full flexibility and strength. Some other fractures that are not displaced or minimally displaced may be treated with a splint or some other easily removable supportive device and early range of movement exercises.

For those radial head fractures that are large, displaced, comminuted or involve joint dislocation, treatment typically involves surgical intervention. This may include anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anesthetic) followed by internal fixation (e.g. using plates or screws), bony excision or immobilization in a plaster cast for a number of weeks. The plaster cast will usually extend above the elbow and down to the hand, leaving the fingers and thumb free.

The orthopaedic surgeon will determine the most suitable treatment based on a number of factors such as injury severity, location, involvement of other structures etc.

Evaluation of the radial head fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed and the orthopaedic specialist has indicated it is safe to begin physiotherapy, rehabilitation can begin as guided by the treating physiotherapist.

One of the most important components of rehabilitation following a radial head fracture is that the patient rests sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the radial head should also be avoided particularly lifting, weight bearing, pushing or pulling activities. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free and the orthopaedic specialist is happy for the patient to do so, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physiotherapist.

Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the radial head fracture altogether.

Patients with a radial head fracture should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as soft tissue flexibility and strength are quickly lost with immobilization or inactivity. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Prognosis of a radial head fracture

Patients with a radial head fracture usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in weeks to months and should be guided by the treating physiotherapist and specialist. In patients with severe injuries, involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged.

Physiotherapy for a radial head fracture

Physiotherapy treatment is vital in all patients with a radial head fracture to hasten healing and ensure an optimal outcome. Treatment may comprise:

• soft tissue massage
• joint mobilization
• electrotherapy (e.g. ultrasound)
• taping or bracing
• exercises to improve strength and flexibility
• education
• activity modification
• a graduated return to activity plan

Other intervention for a radial head fracture

Despite appropriate physiotherapy management, some patients with a radial head fracture do not improve adequately and may require other intervention. The treating physiotherapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured radial head. In rare cases, some patients who are initially managed conservatively may require surgery to stabilize the fracture and a bone graft to aid fracture healing, or sometimes an arthroscope may be required to remove any pieces of loose bone that are trapped inside the elbow joint.

Exercises for a radial head fracture

The following exercises are commonly prescribed to patients with a radial head fracture following confirmation that the fracture has healed, and the orthopaedic surgeon has indicated it is safe to begin pain free mobilization. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Elbow Bend to Straighten

Bend and straighten your elbow as far as possible pain-free (figure 3). Repeat 10 times provided there is no increase in symptoms.

Figure 3 – Elbow Bend to Straighten (left side)

Forearm Rotations

Begin this exercise with your elbow at your side and bent to 90 degrees (figure 4). Slowly rotate your palm up and down until you feel a mild to moderate stretch pain-free. Repeat 10 times provided there is no increase in symptoms.

Figure 4 – Forearm Rotations (right side)

Tennis Ball Squeeze

Begin this exercise holding a tennis ball (figure 5). Squeeze the tennis ball as hard as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times provided there is no increase in symptoms.

Figure 5 – Tennis Ball Squeeze (right hand)

Physiotherapy products for a radial head fracture

Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with a radial head fracture include:

1. Slings
2. Elbow Braces
3. Ice Packs and Heat Packs
4. Resistance Band (for strengthening)

To purchase physiotherapy products for a fractured radial head, visit the PhysioAdvisor Shop.

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