Radial Head Fractures and Dislocations Clinical Presentation

Updated: Apr 20, 2020
  • Author: Steven I Rabin, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Presentation

History

A patient with radial head fracture-dislocations usually presents with a history of a fall on the outstretched hand. Blunt or penetrating trauma rarely causes radial head injury. The wrist, especially the distal radioulnar joint, may be damaged simultaneously, and the presence of wrist pain, grinding, or swelling should be determined.

The presence of bleeding, even with small puncture wounds, should alert the examiner to the possibility of open injury. Neurovascular symptoms of numbness, tingling, or loss of sensation should be identified to rule out nerve or vascular injury. The presence of severe pain should alert the examiner to the possibility of compartment syndrome.

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Physical Examination

Patients with radial head fractures and dislocations present with localized swelling, tenderness, and decreased motion. The physician must carefully examine any wounds to make sure that no open fractures are present. Evaluating wounds over the subcutaneous border of the ulna is especially important in fracture-dislocations for ensuring that open fractures are not missed. The examiner should palpate the elbow, especially the radial head, feeling for deformity, and should also examine the wrist, especially feeling for stability of the distal radioulnar joint.

Because all three major nerves of the forearm are in danger with elbow fractures and dislocations, the examiner should also carefully assess neurovascular function for all of the nerves of the forearm and hand. Radial nerve function is especially important to assess with displaced fractures through the neck of the radius. The motor (posterior interosseous) branch provides extension for the fingers and wrist (see Anatomy).

The examiner must also assess the firmness of all compartments, check for pain with passive stretch, and measure compartment pressures if in doubt to avoid missing compartment syndromes. Elbow stability needs to be assessed even with seemingly nondisplaced radial neck fractures. The elbow is tested with valgus stress at 30° of flexion to determine the competency of the medial collateral ligament.

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