Radial Head Fractures
Radial head fractures are common, accounting for 1 in 5 of all elbow fractures. Usually the person falls on an outstretched hand with their hand twisted to the ground.
They are more frequent in women than in men and occur most often between 30 and 40 years of age. Approximately 10 percent of all elbow dislocations involve a fracture of the radial head. Radial head fractures are less common from falling directly on the elbow. The fracture may not be visible on initial x-rays, but can usually be seen if the x-ray is taken three weeks after the injury.
Most fractures can be treated without surgery but better results are definitely achieved with internal fixation of the more complex injuries.
Radial head fractures are often associated with ligament injuries around the elbow and forearm. Combined surgery is often required to fix these complex soft tissue injuries as well as the bone fracture.
Problems can occur because of damage to the joint lining surface at the time of the injury which lead to arthritis or with stiffness or instability from the soft tissue injuries. Not all of these are amenable to further surgical correction.
Some fractures are too complex to allow reconstruction of the bone. In these cases the radial head may be replaced with a metal component which allows the elbow to remain stable and the soft tissues to remain balanced. The results of this procedure are often quite gratifying initially but can deteriorate with time.
The prominent bone at the tip of the elbow is called the olecranon. It is part of the bone called the ulnar and is almost directly under the skin. Olecranon fractures are among the most common elbow fractures.
In older patients most are caused by the pull of the triceps muscle combined with bending over the end of the humerus. In younger patients the mechanism of fracture is usually direct trauma. Direct trauma produces complex fracture patterns, which may be associated with other fractures or dislocations. It is possible for nerve injury to occur at the same time.
Almost all of these fractures require surgery. This is to restore the joint lining surface in the hope of preventing arthritis. Sometimes if the fragments are too small to be fixed the triceps tendon can be stitched directly into bone to allow functional use of the elbow.
Most olecranon fractures heal, and the vast majority of patients recover a functional range of motion. More than half of all patients never fully straighten their elbows fully ever again. Pain is usually not a problem and often relates to symptomatic hardware. Hardware complications are frequent and further surgery to remove the metal is almost always required.
Failure of the fracture to unite is uncommon (5% of cases) and is usually fixable with further surgery (with or without supplemental bone grafting).
If stiffness develops then usually we will wait for the fracture to unite and deal with the stiffness 6 months later when the hardware is removed (see stiff elbow release).