Radial head fractures are common elbow injuries that can range from undisplaced partial fractures to comminuted fractures. They are often caused by falls onto the elbow or outstretched hand. Treatment depends on the Mason classification and may involve closed reduction, open reduction with screws or plates, or fragment removal. The goal is a pain-free range of motion. Postoperative care involves splinting followed by gradual exercises over 3-4 weeks.

1. Radial Head Fracture
Dr. Ashiqur Rahman
Resident Orthopedics
Dhaka Medical college Hospital

2. Introduction
 Radial had fractures are the most common fracture of the elbow in
adults. Radial head fracture can be occur as an isolated injury or as a
part of more complex injury like:
- Complex elbow dislocation (“terrible triad”)
- Essex-Lopresti injury.
 When confirmed that the fracture is in isolation, the goal of
treatment is pain-free, stable arc of motion in flexion-extension and
pronation-supination.

5.  Mechanism of injury:
- Fall on the elbow
- Fall on an outstretched hand with the elbow extended.
 Associated Injuries with Radial Head Fractures:
- Tears of the LCLs and/or MCLs
- Dislocations of the elbow
- Fractures of the coronoid, capitellum, olecranon, and proximal
ulna
- Rupture of the interosseous membrane

6. Three types of fracture are identified and classified by Mason:
(i) Type I – Undisplaced partial articular fracture of the radial
head.
(ii) Type II – displaced (>2 mm) partial articular fracture of the
radial head
(iii) Type III – comminuted radial head fracture.
Additional type has been proposed:
(iv)Type IV: Radial Head Fracture with elbow dislocation
 CT or MRI may be indicated to better understand the injury; the
associated lateral ligament avulsion

8. Clinical features:
-The Dx is often missed, but tenderness on pressure over the
radial head.
- And pain on pronation & supination should suggest the
diagnosis.
- A firm block on forearm rotation should not be ignored.

9. Applied anatomy relating to radial head #
- The radial head consists of a concave dish which articulates
with the capitellum and a flattened articular margin which
articulates with the lesser sigmoid (radial) notch of the ulna.
- A ‘safe zone’ for placement of a plate on the non-articular
margin of the proximal radius has been defined.
- ‘Safe zone’ best identified during surgery by positioning the
forearm in neutral rotation and placing the plate 10-degree
anterior to the mid-axial line.

10.  The radial head is not circular but
is somewhat elliptical in shape.
 Furthermore, the radiocapitellar
dish is also elliptical and typically
offset from the neck of the
radius.

11. TREATMENT OF MASON TYPE I #
 Undisplaced partial articular
fractures (or head splits) have a
good prognosis with non-surgical
management
 pain relief and mobilization as
comfort allows.
 Most will regain a pain-free
elbow with only a slight loss of
extension the most common
sequel.

12. Treatment of Mason type-II #
 Reduce the partial fracture, taking
care not to disrupt the periosteum;
tamps, dental picks, or Freer
elevators can be used as needed.
 Stabilize the reduction with one or
two small screws.
 Occasionally, a buttress plate can
be useful if the apex of the fracture
is comminuted and a large defect
remains under the articular
segment.

13. Treatment of Mason type-III #
 If needed for improved exposure, release the origin of the lateral
collateral ligament; this will be repaired at the end of the procedure.
 Reduce and provisionally fix the articular surface with Kirschner wires.
 Occasionally, removing the fragments and assembling them on the
back table may facilitate reduction.
 Protect the posterior interosseous nerve by pronating the forearm.

14.  Apply a small plate along the lateral surface of the proximal radius
with the wrist in neutral (safe zone) and secure it with lag screws as
needed.
 Bone graft the defect if needed.
 Check pronation and supination of the forearm.

15. Post operative care
- The arm is placed in a molded.
- Posterior plaster splint at 90 degrees.
- At 3 to 7 days, the splint is removed and the arm
is supported in a sling.
- At about that time, active and active-assisted exercises
are begun.
- The patient should discontinue the sling at 3 weeks.
- Gradually increasing the exercises as tolerated.
- Forceful manipulation of the elbow is never permitted.