eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Radial Head Fractures: Workup

Author: Steven I Rabin, MD, Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic
Contributor Information and Disclosures

Updated: May 14, 2009

Workup

Laboratory Studies

  • No laboratory tests are relevant.

Imaging Studies

  • Most radial head injuries can be assessed adequately with standard plain radiography of the elbow. Normal radiographic examination findings demonstrate that the radial head is aligned with the capitellum on all views. A dislocation of the radial head can be easily missed if all radiographs are not carefully examined for this relationship. For the normal elbow, a line drawn through the radial head and shaft should always line up with the capitellum, and with a supinated lateral view, lines drawn tangential to the head anteriorly and posteriorly should enclose the capitellum. With a radial head dislocation, these radiographic findings are disrupted. Images 2-3 are examples of an injury that appears to be a simple ulna fracture when only the anteroposterior view is evaluated, but it clearly has a dislocated radial head on the lateral view. As with any fracture assessment, 2 views perpendicular to each other are always required.
The radial head must be aligned with the capitell...

The radial head must be aligned with the capitellum on all views. Simple ulna fracture on anteroposterior view; radial head appears in place but see Image below.

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The radial head must be aligned with the capitell...

The radial head must be aligned with the capitellum on all views. Simple ulna fracture on anteroposterior view; radial head appears in place but see Image below.


The radial head must be aligned with the capitell...

The radial head must be aligned with the capitellum on all views. Dislocated radial head is observed on the lateral radiograph.

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The radial head must be aligned with the capitell...

The radial head must be aligned with the capitellum on all views. Dislocated radial head is observed on the lateral radiograph.

  • In rare circumstances, CT scanning of the elbow is useful to define fracture patterns.

Diagnostic Procedures

  • Most radial head fractures and dislocations are well defined by the findings on clinical examination and imaging studies. If a high index of suspicion exists for an occult fracture, the joint can be aspirated. Fat globules in the fluid imply a fracture. If suspicious wounds are present and an open fracture or dislocation is suspected, the joint can be injected. If fluid comes out of the wound, then the wound communicates with the joint.

More on Radial Head Fractures

Overview: Radial Head Fractures
Workup: Radial Head Fractures
Treatment: Radial Head Fractures
Follow-up: Radial Head Fractures
Multimedia: Radial Head Fractures
References
Further Reading
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References

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  2. Jackson JD, Steinmann SP. Radial head fractures. Hand Clin. May 2007;23(2):185-93, vi. [Medline].

  3. Tejwani NC, Mehta H. Fractures of the radial head and neck: current concepts in management. J Am Acad Orthop Surg. Jul 2007;15(7):380-7. [Medline].

  4. Rosenblatt Y, Athwal GS, Faber KJ. Current recommendations for the treatment of radial head fractures. Orthop Clin North Am. Apr 2008;39(2):173-85, vi. [Medline].

  5. Pike JM, Athwal GS, Faber KJ, King GJ. Radial head fractures--an update. J Hand Surg [Am]. Mar 2009;34(3):557-65. [Medline].

  6. Schatzker J. The Rationale of Operative Fracture Care. New York, NY:. Springer Verlag;1987.

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  8. Malmvik J, Herbertsson P, Josefsson PO, et al. Fracture of the radial head and neck of Mason types II and III during growth: a 14-25 year follow-up. J Pediatr Orthop B. Jan 2003;12(1):63-8. [Medline].

  9. Capo JT, Svach D, Ahsgar J, Orillaza NS, Sabatino CT. Biomechanical stability of different fixation constructs for ORIF of radial neck fractures. Orthopedics. Oct 2008;31(10):[Medline].

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  11. O'Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect. 2003;52:113-34. [Medline].

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  13. Harrington IJ, Sekyi-Otu A, Barrington TW, et al. The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review. J Trauma. Jan 2001;50(1):46-52. [Medline].

  14. Ikeda M, Yamashina Y, Kamimoto M, Oka Y. Open reduction and internal fixation of comminuted fractures of the radial head using low-profile mini-plates. J Bone Joint Surg Br. Sep 2003;85(7):1040-4. [Medline].

  15. Judet T. Results of acute excision of the radial head in elbow radial head fracture-dislocations. J Orthop Trauma. May 2001;15(4):308-9. [Medline].

  16. Judet T. The importance of rotational seating of radial head prostheses in achieving valgus stability of the elbow. J Bone Joint Surg Am. Nov 2002;84-A(11):2102; author reply 2102. [Medline].

  17. Liow RY, Cregan A, Nanda R, Montgomery RJ. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury. Nov 2002;33(9):801-6. [Medline].

  18. Moro JK, Werier J, MacDermid JC, et al. Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am. Aug 2001;83-A(8):1201-11. [Medline].

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  21. Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. Oct 2002;84-A(10):1811-5. [Medline].

  22. Sanchez-Sotelo J, Romanillos O, Garay EG. Results of acute excision of the radial head in elbow radial head fracture-dislocations. J Orthop Trauma. Jun-Jul 2000;14(5):354-8. [Medline].

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Keywords

radial head fractures, radial neck fractures, broken arm, broken elbow, radial dislocation, proximal radial migration, displaced radial head and neck fractures, Monteggia fracture-dislocation

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Contributor Information and Disclosures

Author

Steven I Rabin, MD, Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic
Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

Medical Editor

Michael S Clarke, MD, Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine
Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

N Ake Nystrom, MD, PhD, Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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