MANUAL MINORS
A radial head or neck fracture affects the proximal portion of the radius near the elbow. It is one of the most common elbow fractures, typically caused by falls onto an outstretched hand or direct trauma to the joint.
Symptoms include pain on the lateral side of the elbow, swelling, limited forearm rotation (supination and pronation), and difficulty flexing or extending the elbow.
Diagnosis
Diagnosis is based on a physical examination, showing pain and tenderness on the lateral side of the elbow, and restricted forearm rotation. Anteroposterior and lateral X-rays of the elbow confirm the fracture and determine whether it is displaced. In complex fractures, a CT scan may be required to better assess the injury and plan treatment.
Differential Diagnosis
Condition | Distinctive Characteristics |
|---|---|
Elbow dislocation | Obvious elbow deformity with joint dislocation, without radial head fracture. |
Olecranon fracture | Pain in the posterior elbow, with difficulty extending the arm. |
Elbow sprain | Pain without fracture evidence on X-rays, usually following forced movements. |
Supracondylar humerus fracture | Pain in the distal humerus, with elbow deformity, without radial involvement. |
Emergency Management
In the emergency setting, the elbow should be immobilised with a splint to limit movement and prevent further damage. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered to control pain. In cases of displaced or complex fractures, further evaluation is crucial to plan definitive treatment. If neurovascular compromise is suspected, it should be addressed urgently.
Definitive Treatment
Treatment depends on the degree of fracture displacement. Non-displaced or minimally displaced fractures can be managed conservatively with immobilisation for 1 to 3 weeks, followed by physiotherapy to restore mobility.
Displaced or unstable fractures require surgical intervention, which may include fixation with screws, plates, or partial resection of the radial head in severe cases. Post-surgical rehabilitation is essential for restoring elbow and forearm function and mobility.
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