Radial head fracture in Child
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Synopsis
Causes / typical injury mechanism: Within the elbow, there are 3 separate articulations that are responsible for the functionality and stability of this indispensable joint. These articulations are the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The radial head is extremely important as it articulates with the proximal ulna and capitellum and is an important stabilizer for valgus, axial, and posterolateral rotational forces.The typical mechanism of injury involves a patient falling onto an outstretched hand with the forearm in pronation. This creates an axial load across the elbow in which the radial head impacts the capitellum. A direct blow can also result in fracture, although this recognized cause is much more uncommon.
Classic history and presentation: Patients will typically present with pain and limited range of motion (ROM) in the elbow or forearm. The forearm, medial elbow, and lateral elbow can develop ecchymosis and swelling, and there will be tenderness over the radial head.
It should be noted that there is an increased incidence of associated injuries with increasing severity of radial head fractures. It has been reported that incidence of associated injuries increases from 20% in nondisplaced fractures to 80% in comminuted radial head fractures. Some of these associated injuries include capitellar fracture, rupture of the medial collateral ligament (MCL) of the elbow, rupture of the interosseous ligament, posterior elbow dislocation, the terrible triad (posterior dislocation of the elbow with fractures of the radial head and coronoid process), and injury to the wrist. A neurovascular examination should also be performed as posterior interosseous nerve injuries have been reported.
Prevalence: Radial head fractures represent 3%-4% of all fractures and account for about 33% of all elbow fractures, making it the most common fracture around the elbow in adults. In the pediatric population, radial head fractures are less common, accounting for 4%-20% of all elbow injuries and < 1% of total pediatric fractures.
- Age – The mean age at time of injury is 43-47 years.
- Sex / gender – There is a slightly higher incidence in female patients as compared to male patients.
The Mason classification –
- Type I: Undisplaced segmental / marginal fracture; intraarticular displacement < 2 mm
- Type II: Displaced segmental fracture; intraarticular displacement > 2 mm or angulated
- Type III: Comminuted fracture
- Type IV: Fracture associated with posterior dislocation
Codes
ICD10CM:S52.126A – Nondisplaced fracture of head of unspecified radius, initial encounter for closed fracture
SNOMEDCT:
263196008 – Fracture of radial head
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Dislocation of the elbow
- MCL injury of the elbow
- Monteggia fracture
- Capitellum fracture
- Coronoid fracture
- Distal humerus fracture
- Ulna / olecranon fracture
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Management Pearls
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Therapy
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References
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Last Reviewed:05/22/2021
Last Updated:04/19/2022
Last Updated:04/19/2022
Radial head fracture in Child