From the Guidelines
Radial head fracture should be suspected in patients with pain localized to the lateral elbow, especially during pronation and supination movements of the forearm, and tenderness directly over the radial head, which can be palpated approximately 1 cm distal to the lateral epicondyle, as these clinical signs and symptoms are highly suggestive of this injury, even in the absence of X-ray confirmation. The clinical presentation of a radial head fracture typically includes a history of falling onto an outstretched hand or direct trauma to the elbow, as reported by patients 1. On examination, key findings include:
- Limited range of motion, particularly with forearm rotation, elbow flexion, and extension
- Swelling and bruising around the lateral elbow
- The "fat pad sign" may be clinically detectable as fullness in the posterior aspect of the elbow
- Pain exacerbated by specific maneuvers, such as resisted wrist extension, passive forearm pronation and supination, or axial loading of the radius by pressing on the palm while the elbow is extended
- Crepitus might be felt during movement in some cases These findings are crucial for suspecting a radial head fracture, but it's essential to note that definitive diagnosis requires radiographic confirmation, which can be achieved through conventional radiographs or CT scans, with the latter providing more detailed information on fracture morphology and guiding treatment decisions 1.
From the Research
Clinical Signs and Symptoms
The clinical signs and symptoms of a radial head fracture without an X-ray include:
- Elbow pain and swelling, typically presenting after a fall onto an outstretched hand 2
- Loss of elbow motion and pain, which can lead to long-term complications if left untreated 2
- Associated injuries, such as elbow dislocation, neighboring bony fractures, and ligamentous rupture, which can affect the management of the radial head fracture 2, 3, 4
- Limited range of motion and stiffness in the elbow joint 5, 6
Diagnosis and Treatment
Diagnosing a radial head fracture without an X-ray can be challenging, but clinicians should suspect the condition based on the patient's symptoms and physical examination findings. The treatment of radial head fractures depends on the severity of the fracture and the presence of associated injuries. Treatment options include:
- Non-surgical conservative methods for undisplaced or minimally displaced fractures 2, 3, 6
- Surgical fixation, radial head replacement, or excision for more complex or displaced fractures 2, 3, 5, 6
- Open reduction and internal fixation for fractures with two or three articular fragments and little or no metaphyseal comminution 5
- Prosthetic replacement for comminuted fractures or fractures with significant soft tissue or bony injuries 3, 5, 6