eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Radial Head Fractures: Follow-up

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

Outcome and Prognosis

For a good result in radial head and neck fractures and dislocations, achieve the following11 :

  • Mechanical stability with anatomic reduction and stable internal fixation
  • Optimal biology of healing with anatomic reduction, indirect techniques, and maintenance of soft-tissue attachments

Future and Controversies

The treatment of radial head fractures and dislocations is relatively uncontroversial. Less prominent implants are being devised to decrease problems from hardware. Fixed angled locking screw plates are gaining a role, especially when interfragmentary compression cannot be adequately achieved. While internal fixation that fixes the whole head is currently the treatment of choice, partial internal fixation (where the head cannot be fully reconstructed) may have worse results in terms of elbow function than excision or replacement but might have better results in terms of distal radioulnar function. The specific indications for replacement or excision versus internal fixation continue to be studied.

Radial head replacement designs such as bipolar designs and radial head and capitellar replacements are currently available, but there have been limited studies concerning results with these designs.7

 


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
[ CLOSE WINDOW ]

References

  1. Struijs PA, Smit G, Steller EP. Radial head fractures: effectiveness of conservative treatment versus surgical intervention. A systematic review. Arch Orthop Trauma Surg. Feb 2007;127(2):125-30. [Medline].

  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.

  7. Cooney WP. Radial head fractures and the role of radial head prosthetic replacement: current update. Am J Orthop. Aug 2008;37(8 Suppl 1):21-5. [Medline].

  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].

  10. Stuffmann E, Baratz ME. Radial head implant arthroplasty. J Hand Surg [Am]. Apr 2009;34(4):745-54. [Medline].

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

  12. Boyer MI, Galatz LM, Borrelli J, et al. Intra-articular fractures of the upper extremity: new concepts in surgical treatment. Instr Course Lect. 2003;52:591-605. [Medline].

  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].

  19. Rabin SI, Rabin SL. Indications for radial head replacement following elbow trauma. Medscape Orthopaedics and Sports Medicine eJournal [serial online]. September 1997;1(5). Available at: http://www.medscape.com.

  20. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am. Apr 2002;84-A(4):547-51. [Medline].

  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].

  23. Stabile KJ, Pfaeffle HJ, Tomaino MM. The Essex-Lopresti fracture-dislocation factors in early management and salvage alternatives. Hand Clin. Feb 2002;18(1):195-204. [Medline].

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.