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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). 

Relevant Anatomy for a Radial Head Fracture

Figure 1 Relevant Anatomy for a Radial Head Fracture

 

Radial Head Anatomy for Radial Head Fracture

Figure 2 - Radial Head Anatomy

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 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 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, elbow or shoulder, 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 fractured radial head 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 the 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 usually required 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

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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 this condition to hasten healing and ensure an optimal outcome. Treatment may comprise:


Other intervention for a radial head fracture

Despite appropriate physiotherapy management, some patients with this condition 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 injury. 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 fractured radial head 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.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.


Initial Exercises

Elbow Bend to Straighten

Bend and straighten your elbow as far as you can go without pain and provided you feel no more than a mild to moderate stretch (figure 3). Repeat 10 times provided there is no increase in symptoms.

Exercises for Radial Head Fracture - Elbow Bend to Straighten (left side)

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 as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10 times provided there is no increase in symptoms.

Exercises for Radial Head Fracture - Forearm Rotations (right side)

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.

Exercises for Radial Head Fracture - Tennis Ball Squeeze (right hand)

Figure 5 Tennis Ball Squeeze (right hand)


Intermediate Exercises

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Advanced Exercises

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Rehabilitation Protocol for a Radial Head Fracture

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Physiotherapy products for a radial head fracture   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 this condition include:

  1. Slings 
  2. Elbow Braces
  3. Sports Tape 
  4. Compression Bandages
  5. Ice Packs and Heat Packs 
  6. Resistance Band (for strengthening)

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


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Arm Slings

 

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Wheat Heat Pack

 

Sports Tape

 

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Compression Bandages

 

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