Radial head fracture is the most commonly encountered fracture about the elbow. The mechanism of injury is a fall on the outstretched hand with the force transmitted along the radius to the radial head, where it impacts on the capitellum. The result is a fracture of the weaker radial head or neck. An alternative mechanism is direct trauma to the lateral aspect of the elbow directly over the radial head. The patient complains of pain in the elbow, and examination reveals swelling and tenderness laterally. Rotation of the forearm with firm pressure over the radial head will elicit pain. Careful examination of the wrist and forearm for tenderness must be performed to determine whether there has been injury to the distal radioulnar ligaments or to the interosseus membrane. The latter injuries result in radioulnar dissociation (Essex-Lopresti) and proximal migration of the radius if the radial head is excised. Anteroposterior and lateral radiographs are generally sufficient, but occasionally radiocapitellar views are required. A fat-pad sign in a patient with an appropriate mechanism of injury is sufficient to make a presumptive diagnosis of a radial head fracture regardless of whether or not the fracture is visualized ( Flg.261-5).
Undisplaced and minimally displaced fractures are treated with sling immobilization and early ROM. Such patients have excellent results with little morbidity. All other fractures should be referred acutely to an orthopedist, since treatment varies from early motion to radial head excision and prosthetic radial head implantation.
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