Fractures of the proximal radius


 * A fracture of the radial head is most commonly caused by a fall on the hand with the forearm extended in a pronated position.
 * The radial head strikes the humerus and fractures (the same mechanism can lead to a fracture of the capitulum humeri).
 * Wedge fractures, splinter fractures of the capitulum and fractures of the radius (almost always fracture of the radius in children) are typical.

Type I

 * Non-dislocated or minimally dislocated radial head or neck, forearm rotation limited by pain.

Type II

 * Dislocated fractures of the radial head or neck, motion limited mechanically.

Type III

 * Comminuted fractures of the humeral head or neck.

Clinical signs and diagnosis

 * Pain and swelling in the elbow region, palpation of the radial head, functional or morphological limitation of mobility (pronation - supination), haemarthrosis on puncture of the elbow joint, pain in the distal radio-ulnar joint (Essex-Lopresti fracture) on rupture of the interosseous membrane.
 * X-ray in 2 projections, eventually CT is performed.

Type I

 * Cast fixation for 2-3 weeks with early functional treatment.

Type II

 * Open repositions and internal fixation, smaller fragments (up to 1/3 of the head circumference) extirpated.

Type III

 * Not reconstructable, extirpation of the capitellum improves mobility but impairs elbow stability, with associated distal radio-ulnar injury (Essex-Lopresti), replacement of the capitellum with a prosthesis is necessary.

Related articles

 * Fractures of the forearm
 * Radius
 * Ulna