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.

Classification according to Mason

Fracture of the radial head - 3D CT reconstruction

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.

Treatment

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.

Links

Related articles

• Fractures of the forearm
• Radius
• Ulna

Source

• PASTOR, Jan. Langenbeck's medical web page [online]. [cit. 2022-17-12]. <http://langenbeck.webs.com>.