Radial Head Fractures

Radial head fractures most commonly occur after falling on an outstretched hand, and account for one third of fractures at the elbow. (1) (2) (3) The average age for injury changes with gender, with peak incidence of fracture in men between 30 and 40 years and in women between 50 and 60 years. (2)

The majority of radial head fractures are classified as Type I fractures, meaning the bone is non-displaced (has not moved), and these fractures are treated without surgery. (1) (2) (3) A Type II radial head fracture is one where the bone is displaced. (1) (2) (3) Type II fractures are often treated without surgery but may require surgery if the elbow is unstable or there is a mechanical block to movement. (1) (3) Type III fractures are comminuted fractures. A comminuted fracture is a fracture that results in multiple fragments of bone. Type III radial head fractures always require surgery unless other health conditions prevent it. (1) (2) (3)

Figure 1 Radial head fracture - arrow added for clarity

Image taken from: https://www.orthobullets.com/trauma/1019/radial-head-fractures

Type I radial head fractures have good outcomes in 85-95% of patients. (3) Orthopaedic management typically consists of a short period of immobilization and protection (1-2 weeks) followed by moving the elbow early to reduce stiffness and improve function long term. (1) (2) (3) Physiotherapy treatment consists of active elbow flexion and extension (bending and straightening) pronation and supination (turning palm down and palm up) and wrist flexion and extension (bending wrist forward and back). It’s important to do a large number of repetitions (15-20) a few times per day (3-5x) through minimally painful range in order to maintain and regain flexibility.

As pain reduces, stretching and strengthening needs to be employed to maintain normal muscle length and regain the final few degrees of all elbow movements.

A 1981 study by Morrey et al found that most activities of daily living (ADLs) could be performed with 30 to 130 degrees of flexion and 50 degrees of pronation to 50 degrees of supination. (4) Despite this widely used reference for functional elbow motion, a 1995 study by Vasen et al found that ADLs could be completed with 75-120 degrees elbow flexion, if compensation was allowed by other joints. (5) Finally, a 2018 systematic review in Physiotherapy Theory and Practice found that functional elbow movement was highly variable and concluded that 0-150 degrees was required for ADLs based on the maximal reported angle over 66 ADLs. (6) Normal elbow motion is 0-150 degrees flexion and -80-90 degrees pronation-supination. (7)

As our daily activities change with our ever evolving world, it is clear that normal elbow motion is necessary to easily take care of ourselves and do the things we enjoy. If you or someone you know has experienced a radial head fracture, go to physiotherapy as soon as your orthopaedic surgeon allows to ensure you have the best outcome possible.

Stephen Baker graduated from Western University with a Masters of Physical Therapy. He has a passion for helping people who have sustained a fracture or had surgery regain full function and return to their daily adventures. Book with Stephen today.

References

1. Michael F. Githens, MD. Radial Head Fractures of the Elbow. OrthoInfo. [Online] November 2021. https://orthoinfo.aaos.org/en/diseases--conditions/radial-head-fractures-of-the-elbow.

2. Current concepts in the management of radial head fractures. Kodde, Izaäk F, et al., et al. 11, December 18, 2015, World Journal of Orthopedics, Vol. 6, pp. 954-960.

3. Bassett, Ashley and Sanchez-Sotelo, Joaquin. Radial Head Fractures. OrthoBullets. [Online] September 24, 2021. https://www.orthobullets.com/trauma/1019/radial-head-fractures.

4. A biomechanical study of normal functional elbow motion. Morrey, B F, Askew, L J and Chao, E Y. 6, s.l. : American volume, July 1981, The Journal of bone and joint surgery, Vol. 63, pp. 872-877.

5. Functional range of motion of the elbow. Vasen, A P, et al., et al. 2, 1995, The Journal of hand surgery, Vol. 20, pp. 288-292.

6. Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review. Oosterwijk, A M, et al., et al. 7, July 2018, Physiotherapy Theory and Practice, Vol. 34, pp. 505-528.

7. Range of motion measurements: reference values and a database for comparison studies. Soucie, J M, et al., et al. 3, May 2011, Haemophilia, Vol. 17, pp. 500-507.