Radial Head Fracture: Symptoms and Treatment Options

Fracture of the radial head

What is a radial head fracture?

A radial head fracture is a break of the head of the radius, which forms part of the proximal end of the radius bone in the forearm. This type of fracture frequently occurs as a result of a fall onto an outstretched arm and typically affects the elbow joint. Radial head fractures are particularly common in athletes and in people who lead an active lifestyle.

Radial head fractures are classified according to the Mason classification:

• Type I: non-displaced or minimally displaced fracture
• Type II: displaced fracture requiring reconstruction
• Type III: complex, comminuted fracture
• Type IV: fracture with simultaneous dislocation of the elbow joint

You will find further information on different types of fracture on our page about bone fractures.

Typical symptoms of a radial head fracture

A radial head fracture is marked by several characteristic symptoms. The most common signs include:

• Severe pain in the elbow region: this pain often occurs immediately after the injury and can worsen when the elbow is moved.
• Swelling and bruising: the affected area swells and becomes discoloured by bruising.
• Restricted movement of the elbow: those affected find it difficult to bend or straighten the elbow.
• Tenderness to pressure: the area around the radial head is sensitive to touch.

In some cases, a misalignment of the elbow or an audible clicking on movement may also occur. For detailed information on the symptoms and treatment options for elbow injuries, visit our page about elbow surgery.

If a radial head fracture is suspected, it is important to see a doctor without delay. Timely diagnosis and treatment can help to speed up healing and avoid complications.

Diagnosis and examination

Clinical examination

If a radial head fracture is suspected, diagnosis generally begins with a clinical examination by an orthopaedic specialist. The doctor carries out various tests and assessments in order to determine the exact site of the injury and its severity.

The typical steps of the clinical examination include:

• Medical history: the doctor discusses the patient’s medical history, including the circumstances of the accident and any previous injuries.
• Inspection: visual examination of the injured arm for swelling, bruising and deformity.
• Palpation: feeling the elbow to identify painful areas.
• Movement testing: testing the mobility of the elbow in order to assess restrictions and pain during particular movements.

Imaging procedures

Imaging procedures are used to investigate a radial head fracture further. They help the orthopaedic specialist to determine the exact position and extent of the fracture.

• X-ray: the first and most common procedure for diagnosing bone fractures. It gives clear images of bone structures and helps to locate the fracture.
• CT (computed tomography): more detailed images than an X-ray. Useful in complicated fractures for the precise assessment of the fragments and their alignment.
• MRI (magnetic resonance imaging): rarely used for bone fractures, but useful for assessing soft tissue and ligament injuries associated with the fracture.

The choice of imaging procedure depends on the individual situation of the patient and the judgement of the doctor. A precise diagnosis is decisive in determining the best treatment options.

You will find additional information about different fractures in our section on bone fractures. Information pages on the treatment of elbow injuries are available in our elbow surgery section.

Treatment options

There are several treatment options for a radial head fracture, depending on the severity of the fracture. They include conservative methods and surgical procedures.

Conservative treatment methods

Conservative treatment approaches are frequently used for minor fractures or stable injuries in which the bone fragments are not displaced. The main aims of these methods are pain management and the restoration of elbow joint function.

• Immobilisation: temporary immobilisation of the elbow with a splint or a plaster cast for one to two weeks.
• Physiotherapy: after the initial period of immobilisation, physiotherapy is used to restore the mobility and strength of the arm.
• Pain medication: painkillers to relieve the acute pain.

Surgical procedures

Surgery is required if the fracture is displaced, the joint surface is unstable or conservative methods are unsuccessful. The choice of procedure depends on the type and severity of the fracture.

• Open reduction and internal fixation (ORIF): in ORIF, the fracture is realigned through an incision in the skin and fixed with screws or plates.
• Partial resection of the radial head: removal of part of the radial head in order to improve the mobility of the joint.
• Radial head replacement: replacement of the radial head with a prosthesis in severe and complicated fractures.

• Immobilisation: for minor fractures; advantage: minimal invasiveness
• Physiotherapy: after immobilisation; advantage: improved function
• Pain medication: for acute pain; advantage: pain relief
• ORIF: for displaced fractures; advantage: stable fixation
• Partial resection: for complex fractures; advantage: improved mobility
• Prosthesis: for the most severe fractures; advantage: long-term stability

For further details on the surgical procedures used in elbow injuries, visit elbow surgery. You will find more information on specific types of fracture in our section on bone fractures.

Rehabilitation and aftercare

A radial head fracture requires careful rehabilitation and aftercare in order to ensure full recovery and function of the arm. This process includes both physiotherapy and specific rehabilitation measures after surgery.

Physiotherapy

Physiotherapy plays a decisive role in restoring mobility and strength after a radial head fracture. An individually adapted physiotherapy programme helps to improve joint function and to avoid complications such as stiffness or muscle weakness.

Typical physiotherapeutic measures can include:

• Passive and active mobilisation exercises
• Strength training
• Stretching exercises

• Passive exercises: improving mobility
• Active exercises: strengthening the muscles
• Stretching exercises: increasing joint flexibility

Rehabilitation after surgery

Rehabilitation is particularly important after surgical treatment of a radial head fracture. The focus is on promoting healing, restoring arm function and avoiding postoperative complications.

Important elements of postoperative rehabilitation are:

• Control of swelling and pain
• Early mobilisation of the joint
• Gradual increase in loading

• Acute phase: control of pain and swelling
• Early mobilisation: gentle movement and light stretching exercises
• Strength-building phase: progressive strength training and functional exercises

Individual therapy plans are drawn up by specialist physiotherapists and doctors in order to ensure the best possible recovery.

You will find further information on specific surgical methods and elbow procedures on our website. If conservative treatment is preferred, you can read about alternative measures under bone fractures.

Complications and prognosis

Possible complications

A radial head fracture can bring various complications, particularly if it is not treated appropriately. The most common complications include:

• Restricted movement: inadequate healing or scarring of the tissue can lead to restricted mobility in the elbow joint.
• Pain: persistent pain in the elbow region is possible, particularly where healing is incomplete or inflammation becomes chronic.
• Post-traumatic arthritis: one long-term consequence can be the development of post-traumatic arthritis in the affected joint.
• Nerve injuries: in rare cases the injury can cause damage to the surrounding nerves, which may lead to numbness or tingling.
• Malalignment: misalignment of the bone fragments can lead to deformities that impair the functioning of the arm.

• Restricted movement: 10 to 20 per cent; depends on early rehabilitation
• Pain: 15 to 25 per cent; can become chronic
• Post-traumatic arthritis: 5 to 10 per cent; long-term monitoring necessary
• Nerve injuries: under 5 per cent; rare, depends on the type of fracture
• Malalignment: 3 to 8 per cent; risk where reduction is inadequate

Where complications occur, further treatment options are often needed in order to improve the patient’s quality of life.

Long-term prognosis after a radial head fracture

The long-term prognosis after a radial head fracture depends on various factors, including the severity of the fracture, the treatment method chosen and the rehabilitation measures. In general, patients have a good prognosis with appropriate treatment and rehabilitation.

Some factors that influence the prognosis:

• Type of fracture: simpler, non-displaced fractures have better prospects of healing.
• Treatment method: the right choice between conservative treatment and surgery can have a positive effect on the course of healing.
• Rehabilitation: consistent physiotherapy and aftercare can improve the mobility and function of the elbow considerably.
• Patient’s age: younger patients generally heal faster and have a better prognosis than older patients.

• Type of fracture: high influence in simple fractures
• Treatment method: variable, depending on the choice made and how it is carried out
• Rehabilitation: very high, decisive for mobility
• Patient’s age: high influence in younger patients

Patients should understand the importance of continuous aftercare following treatment in order to achieve optimal results and avoid complications. For further information on similar injuries and their treatment, our articles on bone fractures and osteoarthritis therapy are available to you.