What is the treatment for a radial head fracture?

Treatment of Radial Head Fractures

The treatment of radial head fractures depends primarily on fracture displacement, comminution, and associated injuries, with undisplaced or minimally displaced fractures managed non-operatively and displaced fractures requiring surgical intervention. 1

Classification and Initial Assessment

Radial head fractures are the most common type of elbow fractures 2 and are typically classified using the Mason classification:

• Type I: Undisplaced fractures (< 2mm displacement)
• Type II: Displaced partial head fractures (> 2mm displacement)
• Type III: Comminuted fractures involving the entire radial head
• Type IV: Radial head fracture with elbow dislocation (modified classification)

Initial evaluation should include:

• Standard radiographs (3 views) of the elbow
• Assessment for limitations of elbow extension and supination 3
• Evaluation for associated injuries (ligamentous, cartilaginous, or other fractures) 1
• CT scan if available, especially for complex fractures or when associated injuries are suspected 1

Treatment Algorithm

Non-operative Management

For Type I (undisplaced or minimally displaced) fractures:

• Early active range of motion exercises 4
• Brief immobilization (3-5 days) in a posterior splint at 90° of flexion
• NSAIDs for pain and inflammation control
• Ice application during the first 3-5 days for symptomatic relief

Surgical Management

For Type II (displaced partial head fractures):

• Open reduction and internal fixation (ORIF), preferably with headless cannulated screws 1
• Fragment excision may be considered for small fragments that cannot be repaired

For Type III (comminuted) fractures:

• In younger patients or those with associated soft tissue/bony injuries: Radial head prosthetic replacement 1
• In elderly patients with isolated fractures: Radial head excision may be considered 1
• ORIF may be attempted for fractures with limited comminution

For Type IV (fracture with dislocation):

• Surgical management is almost always required
• Radial head replacement is often necessary to maintain elbow stability 4

Post-Treatment Care

• Progressive range of motion exercises should begin after the immobilization period
• Full recovery is typically expected within 6-8 weeks
• Monitor for complications such as:
  • Stiffness
  • Nonunion
  • Post-traumatic arthritis
  • Posterior interosseous nerve injury

Special Considerations

• Associated injuries significantly impact treatment decisions and outcomes 1
• Radial head arthroplasty is preferred over tenuous fracture fixation when there are associated ligament injuries 4
• Smoking increases the rate of nonunion and leads to inferior clinical outcomes

Common Pitfalls to Avoid

1. Failing to identify associated injuries that may affect treatment decisions
2. Inadequate fixation of displaced fractures leading to instability
3. Prolonged immobilization resulting in stiffness
4. Overlooking small radial head fractures that may not be visible on initial radiographs
5. Attempting ORIF on highly comminuted fractures that would be better managed with radial head replacement

The goal of treatment is to restore function and stability of the elbow 5, with treatment strategies evolving to better address the radial head's important role as an elbow stabilizer.