What is the treatment for a radial head fracture?

Treatment of Radial Head Fractures

The treatment of radial head fractures should be based on fracture classification, with non-displaced fractures managed conservatively and comminuted fractures requiring surgical intervention. The approach varies depending on the fracture pattern, displacement, and associated injuries.

Classification and Initial Assessment

• Radiography with 3 standard views is the initial imaging modality of choice for suspected radial head fractures 1
• Mason classification is commonly used to guide treatment:
  • Type 1: Non-displaced fractures
  • Type 2: Partial articular, displaced fractures
  • Type 3: Complete articular, comminuted fractures

Treatment Algorithm

Non-displaced Fractures (Mason Type 1)

• Conservative management with:
  • Brief immobilization (sling or splint) for 1-2 weeks
  • Early active range of motion exercises to prevent stiffness 2
  • Pain control with NSAIDs and ice application during the first 3-5 days

Partially Displaced Fractures (Mason Type 2)

• Non-comminuted fractures:

  • Open reduction and internal fixation (ORIF) with headless cannulated screws 3
  • Excellent outcomes expected with proper fixation 4

• Comminuted Type 2 fractures:

  • ORIF may be attempted but has higher failure rates, especially with associated elbow fracture-dislocations 4
  • Consider radial head excision or replacement if fixation is not feasible

Comminuted Fractures (Mason Type 3)

• Fractures with 2-3 fragments:

  • ORIF may be attempted with satisfactory outcomes 4

• Fractures with >3 fragments:

  • Radial head replacement is recommended as ORIF has high failure rates 2
  • Radial head excision may be considered in elderly patients with unfixable fractures 3

Associated Injuries

• Always assess for associated injuries:

  • Ligamentous injuries (especially medial collateral ligament)
  • Distal radioulnar joint (DRUJ) instability
  • Coronoid fractures
  • Essex-Lopresti lesions

• In cases with associated ligamentous injuries, radial head replacement is preferred over tenuous fixation to maintain joint stability 2

Rehabilitation Protocol

1. Inflammatory Phase (0-7 days):

   • Rest, ice, elevation, and immobilization
   • Pain and swelling management 5

2. Repair Phase (2-8 weeks):

   • Active finger motion exercises should be started immediately to prevent stiffness 1
   • Wrist motion does not need to begin early after stable fracture fixation 1
   • Progressive range of motion exercises after the immobilization period

3. Remodeling Phase (several months):

   • Physical therapy to restore strength, range of motion, and proprioception 5
   • Full recovery typically expected within 6-8 weeks

Important Considerations

• Immobilization should be limited to avoid contractures and loss of strength 5
• A home exercise program is an option for patients after the immobilization period 1
• Patients with unremitting pain during follow-up should be reevaluated 1
• CT scan may be necessary for complex fractures to better visualize fracture morphology

Pitfalls and Caveats

• Avoid prolonged immobilization as it can lead to stiffness and contractures
• Be vigilant for associated injuries that may affect treatment decisions and outcomes
• ORIF of highly comminuted fractures (>3 fragments) has poor outcomes and should be avoided 4
• Consider the patient's age, activity level, and associated injuries when deciding between radial head excision and replacement