What are the consequences of a missed radial head fracture?

From the Guidelines

A missed radial head fracture can lead to several serious consequences, including chronic elbow instability, post-traumatic arthritis, and permanent loss of pronation and supination movements, emphasizing the importance of early diagnosis and treatment. The consequences of a missed radial head fracture can be severe and long-lasting, affecting the patient's quality of life and morbidity. Initially, patients may experience persistent pain, swelling, and limited elbow motion that doesn't improve with time. Without proper treatment, the fracture may heal improperly (malunion) or fail to heal altogether (nonunion), resulting in chronic elbow instability. Long-term complications include post-traumatic arthritis, which develops as the irregular joint surfaces wear down cartilage, causing pain and stiffness. Patients may also develop heterotopic ossification (abnormal bone formation around the joint) or a stiff elbow with permanent loss of pronation and supination movements. Cubitus valgus deformity (outward angulation of the forearm) can occur, potentially leading to ulnar nerve compression and symptoms like numbness or tingling in the hand.

According to the most recent study 1, CT scans can be useful in identifying occult fractures, including fractures of the radial head, olecranon, and coronoid process. Treatment for a delayed diagnosis typically involves pain management with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), physical therapy to maintain range of motion, and possibly surgical intervention if significant functional impairment exists. Surgery might include radial head excision, replacement with a prosthesis, or open reduction and internal fixation, depending on the fracture pattern and time since injury. Early diagnosis and treatment are crucial because the radial head plays a key role in elbow stability and forearm rotation, with proper alignment being essential for normal joint mechanics.

Some key points to consider in the management of radial head fractures include:

• Early diagnosis and treatment are crucial to prevent long-term complications
• CT scans can be useful in identifying occult fractures
• Pain management with NSAIDs and physical therapy can help maintain range of motion and reduce pain
• Surgical intervention may be necessary if significant functional impairment exists
• The type of surgery depends on the fracture pattern and time since injury.

It is essential to prioritize early diagnosis and treatment to minimize the risk of long-term complications and improve patient outcomes, as emphasized by the American Academy of Orthopaedic Surgeons 1.

From the Research

Consequences of Missed Radial Head Fracture

• If a radial head fracture is missed, it can lead to long-term complications, including loss of elbow motion and pain 2.
• Missed radial head fractures may also result in subluxation or dislocation of the elbow and forearm if not properly treated 3.
• Untreated displaced radial head fractures can cause stiffness, functional limitations, loss of strength, and radiographic evidence of arthritis 4.
• In young patients, radial head resection for isolated fracture can present satisfactory results, with low losses of elbow mobility and strength, despite the high presence of osteoarthritic changes or clinical signs of instability 5.
• The diagnosis and treatment of radial head fractures are crucial to prevent long-term complications, and hospital clinicians should understand the diagnosis and treatment of this condition 2.

Treatment Options

• Treatment options for radial head fractures range from non-surgical conservative methods for undisplaced fractures to surgical fixation, radial head replacement, and excision for more complex, displaced fractures 3, 2, 6.
• Open reduction and internal fixation of displaced radial head fractures should only be attempted when anatomic reduction, restoration of articular congruity, and initiation of early motion can be achieved 6.
• Radial head replacement is preferred for displaced radial head fractures with more than three fragments, unstable partial articular fractures, and fractures occurring in association with complex elbow injury patterns if stable fixation cannot be ensured 6.