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Radial head or neck fracture in Child
Other Resources UpToDate PubMed

Radial head or neck fracture in Child

Contributors: Brian Grover, Thomas Rodenhouse MD, Katie Rizzone MD, MPH, Stephanie E. Siegrist MD
Other Resources UpToDate PubMed

Synopsis

Causes / typical injury mechanism: Fractures of the radial head and neck most commonly occur when a patient falls on an outstretched hand (FOOSH), compressing the radial head into the capitellum of the distal humerus. A radial head or neck fracture can also be caused by a direct blow or other trauma.

Classic history and presentation: The patient typically presents after a fall with pain and limited range of motion (ROM) of the elbow, particularly supination and pronation. Point tenderness and pain over the lateral elbow with passive rotation, and an elbow effusion, will be present.

Prevalence: Radial head and neck fractures account for about one-third of all elbow fractures in adults. Radial neck fractures account for 5% of pediatric elbow fractures.
  • Age – If a fracture of the proximal radius occurs, the radial head is more vulnerable in adults while the radial neck is more vulnerable in children. This diagnosis is most common in middle adulthood or in the pediatric population, at age 8-10 years.
  • Sex / gender – There is a slightly higher incidence in females.
Risk factors: FOOSH while the elbow is extended and the forearm pronated.

Pathophysiology: Function and stability of the elbow depends on 3 separate articulations: the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The radial head articulates with the proximal ulna and capitellum and is an important stabilizer for valgus, axial, and posterolateral rotational forces.

There is an increased incidence of associated injuries with increasing severity of radial head or neck fractures: 20% in nondisplaced fractures and up to 80% in comminuted radial head fractures.

Grade / classification system:
Mason classification of radial head fractures
  • Type 1 – Undisplaced segmental / marginal fracture; intra-articular displacement less than 2 mm.
  • Type 2 – Displaced segmental fracture; intra-articular displacement more than 2 mm or angulated.
  • Type 3 – Comminuted fracture.
  • Type 4 – Fracture associated with posterior dislocation.
O'Brien classification of radial neck fractures
  • Type I – less than 30 degrees of angulation
  • Type II – 30-60 degrees of angulation
  • Type III – more than 60 degrees of angulation
Related topic: Essex-Lopresti fracture

Codes

ICD10CM:
S52.126A – Nondisplaced fracture of head of unspecified radius, initial encounter for closed fracture
S52.136A – Nondisplaced fracture of neck of unspecified radius, initial encounter for closed fracture

SNOMEDCT:
263196008 – Fracture of radial head
263197004 – Fracture of radial neck

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Distal humerus fracture
  • Ulnar collateral ligament (UCL) sprain (see Medial ulnar collateral ligament of elbow injury, Ulnar collateral ligament of thumb injury)
  • Elbow dislocation
  • Coronoid fracture
  • Monteggia fracture
  • Radius and ulna fracture
Pitfalls: Determine the integrity of nearby structures as there are often associated injuries to the coronoid process, MCL, interosseous ligament of the forearm, distal radioulnar joint, wrist, and/or shoulder.

The "Terrible triad injury of elbow" is a posterior elbow dislocation with fractures of the radial head and coronoid process.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:03/13/2023
Last Updated:03/16/2023
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Radial head or neck fracture in Child
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