Radial Head Fractures Workup

  • Author: Steven I Rabin, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jun 14, 2011
 

Laboratory Studies

  • No laboratory tests are relevant.
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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. The images below 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 capitelluThe 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 capitelluThe 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.

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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.
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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

N Ake Nystrom, MD, PhD  Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

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

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, Leonard M Miller 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.

References

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Congenital radial head dislocation.
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 capitellum on all views. Dislocated radial head is observed on the lateral radiograph.
Soft tissue injury. Soft tissues are as important as bone in determining functional outcome.
Isolated radial head dislocation is almost always treated closed.
Minimally displaced radial head/neck fractures can be treated with early motion.
Floating elbow. Combined Monteggia fracture with dislocation and supracondylar humerus fractures. Treatment of a floating elbow requires fixation of both fractures.
Displaced radial head fracture.
Radial head fracture fixation.
Radial head fracture in a child.
Radial head fracture in a child.
Radial head replacement, Monteggia variant and the radial head could not be salvaged.
Radial head replacement, temporary spacer.
Radial head excessive excision. Do not excise distal to the annular ligament because the forearm becomes unstable.
Radial head replacement, salvage with radial head spacer.
Unsuccessful open reduction of Monteggia fracture-dislocation.
Displaced radial head fracture.
Fixation with hardware pain.
Same patient as in Image above. Pain was resolved after hardware removal.
Synostosis after Monteggia fracture-dislocation; see Image below.
Improved motion after synostosis resection.
Monteggia variant with radial head fracture.
Fixation of both radial head and ulna.
Table. Classification of Monteggia fracture-dislocations
TypeDescriptionEquivalent(s)%
Type IAnterior dislocation of the radial head and anterior angulation of the ulna fractureRadial head or neck fracture instead of dislocation60
Type IIPosterior dislocation of the radial head and posterior angulation of the ulna fracturePosterior elbow dislocation



Radial head or neck fracture instead of dislocation



105
Type IIILateral dislocation of the radial head with proximal ulna fractureRadial head or neck fracture instead of dislocation20
Type IVAnterior dislocation of the radial head and proximal shafts of both bones fractured at same levelRadial head or neck fracture instead of dislocation5
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