Treatment of Radial Head Fractures
The treatment of radial head fractures should be based on fracture characteristics, with non-displaced or minimally displaced fractures managed conservatively with early active range of motion, while displaced or comminuted fractures require surgical intervention through open reduction internal fixation (ORIF) or radial head replacement. 1
Classification and Initial Assessment
Radial head fractures are the most common fractures involving the elbow, accounting for approximately 5% of all adult fractures 2. The Mason classification is commonly used to guide treatment:
- Type I: Non-displaced or minimally displaced fractures
- Type II: Displaced partial fractures
- Type III: Comminuted fractures
- Type IV: Fractures with associated elbow dislocation
Key assessment points:
- Evaluate for mechanical block to motion
- Check for associated ligamentous injuries
- Assess for elbow stability
- Obtain appropriate imaging (radiographs, CT scan when needed)
Treatment Algorithm
Non-displaced or Minimally Displaced Fractures (Mason Type I)
- Conservative management with early active range of motion
- Brief immobilization (1-2 weeks) followed by progressive mobilization
- Avoid prolonged immobilization as it can lead to stiffness 3
Displaced Partial Fractures (Mason Type II)
- Options include:
- Conservative treatment with early ROM if stable
- ORIF with headless cannulated screws for better functional outcomes 4
- Decision factors:
- Fragment size
- Degree of displacement
- Presence of mechanical block
Comminuted Fractures (Mason Type III)
- Radial head replacement is recommended for fractures with more than 3 fragments 1
- ORIF may be attempted for select cases with limited comminution
- Avoid tenuous fixation, especially with associated ligament injuries
Complex Fractures with Associated Injuries (Mason Type IV)
- Surgical treatment is mandatory to restore elbow stability
- Radial head arthroplasty is preferred over tenuous fracture fixation when there are associated ligament injuries 1
- Address all associated injuries (ligamentous, cartilaginous, other fractures)
Surgical Techniques
Headless cannulated screws: Preferred for simple displaced fractures 4
- Advantages: smaller incision, fewer complications, less hardware removal
Plate fixation: Reserved for fractures with neck comminution 4
Radial head replacement: For comminuted unfixable fractures, especially in:
- Younger patients
- Cases with associated soft tissue or bony injuries 4
Radial head excision: May be considered for unfixable fractures in elderly patients without associated injuries 4
Rehabilitation
- Early active range of motion exercises are crucial to prevent stiffness 3
- Progressive strengthening once fracture healing is evident
- Monitor for complications such as:
- Elbow stiffness
- Chronic instability
- Cartilage damage
Complications and Pitfalls
- Elbow stiffness: Most common complication, may require arthroscopic arthrolysis 3
- Chronic instability: Can occur with inadequate treatment of associated ligament injuries
- Post-traumatic arthritis: More common with comminuted fractures or those with articular involvement
- Hardware complications: May require removal, especially with plate fixation
A retrospective study of 70 patients requiring surgical revision after conservative treatment of radial head fractures found that 53 patients had posttraumatic elbow stiffness and 34 had lateral ligament instability 3. This underscores the importance of appropriate initial treatment and early mobilization.