Radial head fracture

introduction

A radial head fracture is a broken bone at the upper end of the spoke (radius) of the forearm. It accounts for around 3% of all bony injuries in the population and mostly occurs as part of falls. Depending on the extent of the injury, different forms are described, which can be treated differently depending on the accompanying injuries and clinical characteristics.

causes

The most common cause of a radial head fracture are Fall on the outstretched armif the person concerned supports himself with his hand on the ground, for example when falling. In this case, due to the vertical force acting on the extended arm, enormous pressure is exerted on the radial head, which cannot always withstand the load. A fracture can result. However, a radial head fracture can be caused by any other Violence on the arm arise, for example, by a strong blow on the arm at the level of the radial head.

Symptoms

Patients with a radial head fracture usually complain Pain in the area of ​​the radial head, which extends into the hand can radiate. When you press the Radius head the pain can be localized there and is strongest at this point. The pain also usually increases when the forearm is turned in or out. In addition to the pain, there is often one swelling in the radius head area as well as a bruise. Depending on the force exerted on the arm, the Cubit (Ulna) be injured. Since in the elbow area also the Radial nerve runs, it can also be affected by an injury there. When it is severed, for example, the Sensitivity of the first three fingers come out of hand.

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Pain

A radial head fracture can be very painful. Usually there is pronounced tenderness to pressure directly above the affected radial head. The pain can also radiate through the forearm and into the hand. The pain can often be increased by rotating the forearm in and out. Accompanying injuries to a radial head fracture can lead to a greater intensity of the pain, for example if the other forearm bone is also damaged or nearby nerves or ligaments have also been affected. The injury to blood vessels or the fracture itself can lead to pronounced joint effusions, which are also associated with a painful restriction of movement in the affected elbow joint. A therapeutic joint puncture can relieve pain by relieving the pressure built up by the fluid in the joint.

Accompanying injuries

With a radial head fracture, various accompanying injuries can occur depending on the extent of the violence. It is particularly common to have one in parallel Damage to the inner collateral ligament of the elbow. Neighboring fractures in the humerus or ulna are also not uncommon. Of course, the fracture of the radial head can also be associated with other fractures, for example with one Carpal fracture or the part of the radius near the wrist. The ulna and radius are fused together by a connective tissue membrane. Especially at Debris fractures can this membrane (Membrana interossea) tear. Eventually, it can be concomitant to a radial head fracture too Nerve injuries come. Are particularly at risk Radial nerve and the Ulnar nervewhich both run in the area of ​​the elbow joint. These nerves can be affected, especially when debris breaks. However, a complete severing of the nerves with permanent damage is rare.

diagnosis

The suspicion of a fracture of the radial head usually arises from the typical symptoms and the accident mechanism described by the patient. Through the physical exam with triggering a Pressure pain in the area of ​​the radial head this suspicion can often be confirmed. To secure the diagnosis, a X-ray image on which the fracture can then be directly identified. It is also important that Accompanying injuries be excluded. It is therefore imperative to check whether the sensitivity of the hand and forearm is maintained in order to achieve a Injury to nerves to be clarified. The X-ray can also be used to assess whether the ulna or humerus are broken. If the fracture is not clearly visible on the X-ray, a Computed Tomography (CT) or Magnetic resonance imaging (MRI) be made.

classification

The radial head fracture is often divided according to the so-called AO classification. A distinction is made between three types of fracture: Fractures without joint involvement (so-called extra-articular fractures), Fractures in which the joint also affected but is only one of the two forearm bones broken is as well as fractures in which the joint is affected and both forearm bones broken are.

As an alternative to the general AO classification, the radial head fracture can also be according to the frequently used classification mason to be grouped. This classification also distinguishes between three types of fractures.

• Type 1 are called fractures in which the Bone fragments not shifted against each other are.
• Type 2 in contrast to type 1 has a Displacement of the pieces of bone on
• Type 3 finally puts the group of debris represent.

There are other classifications according to which a radial head fracture can be classified, but there is no international standard as to which classification is generally to be preferred.

therapy

The radial head fracture can be treated either conservatively or surgically. Which of the two procedures is chosen is decided depending on the type and extent of the violation. If it is a simple fracture without displacement of the bone fragments, conservative therapy can often be successful. In the case of fragmentary fractures, open fractures, accompanying injuries or greater displacement of the bone fragments relative to one another, surgical treatment of the fracture of the radial head is usually recommended. Possible accompanying injuries can then be treated in the same procedure.

Conservative therapy

If surgery is not required, the arm is usually immobilized in an upper arm cast. The elbow is fixed in a 90 ° position. It is important to mobilize the elbow joint at an early stage, as it can otherwise stiffen. In the case of radius head fractures that can be treated conservatively, the first physiotherapeutic exercises can often be started after a few days. After the plaster treatment, a plastic splint is used that stabilizes the elbow for some time. All in all, the conservative therapy, including the physiotherapy exercises, takes about six weeks until the patient is largely free of symptoms. If the movement is severely restricted due to joint effusion, there is also the option of therapeutic joint puncture as a conservative measure. The fluid is drained from the joint through a cannula under local anesthesia. This is often a great relief for the patient.

Read about this too Elbow brace

Operative therapy

In grades 2 and 3, i.e. when bone fragments have shifted against each other, surgery should be performed to avoid complications and incorrect healing. The fragments are brought back into the correct position and then fixed with screws. Surgery for a fracture of the radial head is necessary if the fracture is unstable, the bone fragments have shifted significantly from one another or if there is a restriction in forearm rotation. The bone pieces are then surgically returned to their anatomically correct position and fixed with plates or screws. In the case of pronounced debris fractures, it may be useful to remove the entire radial head and replace it with a prosthesis in order to maintain better functionality of the elbow joint.

After the operation, the arm is fixed in a plaster splint for up to ten days before physiotherapy exercises are started. The exercises are performed with increasing intensity and increasing range of motion. After six to eight weeks, an almost normal level of function should be reached again. Overall, good results are achieved with the surgical procedures, but in the long term, certain mobility restrictions can persist with both surgical and conservative therapy measures.

supportive physiotherapy

After a radial head fracture, it is important to relearn how the elbow works. Physiotherapeutic treatment is prescribed for this. Early functional therapy is particularly important in conservative therapy. Here, gentle, adapted movement exercises are started after around 7 days. After an operation, physiotherapy is also used for rehabilitation, where the elbow joint is then trained according to the surgeon's instructions. The patient usually also receives a "homework program" in which he independently performs simple exercises at home without a physiotherapist. In physiotherapy, therapeutic techniques and physical therapy measures are used in addition to exercises.

Complications

Complications can occur with the various therapy methods for fracture of the radial head. In conservative therapy there is a fundamental risk that the bone fragments don't heal back together like thisas they were originally anatomically arranged. The result is a deformed radial head, which in turn can hinder the function of the elbow joint. As a result, it is not uncommon for one to occur Osteoarthritis in the elbow jointwhich in turn can be accompanied by pain and restricted mobility.

Also through the plaster splint Complications can arise, especially if the patient is immobilized for too long plaster to be watched. By fixing in the 90 ° position, stiffen the elbow joint (so-called Contracture). This manifests itself in the fact that the joint can no longer be fully stretched after the cast has been removed. Often the Outward rotation (Supination) of the forearm with special needs.

During operations there is a risk of Injury to surrounding structuressuch as the nerves and ligaments that run around the elbow joint. In the worst case, it can result long-term failure symptoms surrender. Furthermore, it can also lead to a Osteoarthritis development come in the joint, since even these interventions cannot achieve a 100% success rate.

Possible consequential damage

With a radial head fracture, consequential damage and complications can occur. In the case of insufficient immobilization, pseudarthrosis can develop, for example. These are bones that have not grown stably together. The elbow joint can lose its mobility and the arm its resilience.

Nerve damage can lead to abnormal sensations or even paralysis in the area of ​​the forearm due to the course of the radial nerve in the immediate vicinity of the radial head. A precise documentation and examination of the nerve function should be carried out in order to be able to intervene early in the event of damage.

Permanent restriction of movement of the elbow joint can also remain as a long-term consequence of a radial head fracture. The radial head is particularly important for rotational movements (pronation and supination) of the forearm. With radial head resection or poorly healed fragments, joint mobility can remain permanently restricted.

forecast

All in all, the current therapy methods for fractures of the radial head can usually achieve a satisfactory result. Nevertheless, no procedure offers an optimal long-term result with absolute certainty. It is not uncommon for certain restrictions in the mobility of the affected elbow joint to remain, regardless of the therapy method chosen. With both conservative and surgical therapy, however, the elbow joint in question should be able to be moved to an almost normal extent again after about six weeks without causing severe pain. After ten to twelve weeks, the joint can also be cautiously put back under more pressure. In general, the better the prognosis of the fracture, the less complicated it is. Simple, stable fractures without displacement of the bone fragments therefore have a better prognosis than unstable, displaced fractures or comminuted fractures.

Healing time

The healing of the radial head fracture depends on various factors. The age of the patient, his general condition and secondary diseases play an important role. Furthermore, the healing time depends on the type of fracture and the therapy chosen.

A radius head fracture that has been treated conservatively can be practiced slowly again after just 7 days of immobilization. A final examination takes place after approx. 6 weeks with regular x-ray checks, after which the fracture is usually well healed. Healing can occur faster in children. Complications prolong the healing process. After an operation, the healing depends on the result of the operation. It may be necessary to remove fixation material after several weeks of healing. If the elbow joint is heavily involved, it may take longer to heal. Normally, however, healing should not take longer than 6 weeks even after an operation, and up to 12 weeks if the joints are involved.

You can find more information at: Duration of a radius fracture

When can the elbow be loaded again?

The strength of the elbow depends on the healing process. After conservative therapy, active exercises or exercises carried out with the assistance of an expert therapist can be started again after about 7 days. If necessary, however, certain movements are not yet allowed again, and lifting objects or supporting them is then not yet possible again. Further healing of the fracture is necessary for this.

The individual healing process can be checked by an X-ray examination. The doctor will determine the individual time when the patient can use his elbow fully again. Usually the fracture is stable again after 6 months. After surgical therapy, this time depends on the information provided by the surgeon.

How long are you unable to work?

The duration of incapacity for work is issued in the hospital for the first week and then assessed by the treating outpatient doctor. The duration of an incapacity for work depends individually on the work demands on the patient. For example, a patient who makes phone calls on the headset at work will be able to work again more quickly than a painter or bricklayer who strains his arms for his daily work.

In the case of demanding activities, incapacity for work can be issued for the entire healing period, but at least until the load is stable. Stability stability means that the patient is allowed to fully load his arm and use it again. If pain occurs during work or swelling occurs, a doctor should be consulted if necessary.

personal injury compensation

Whether a patient is entitled to compensation for pain and suffering after a radial head fracture is an individual decision. When determining the possible compensation for pain and suffering, it depends on the long-term functional restrictions and permanent damage that a patient suffers from his injury. However, these often only become apparent one to two years after the injury. In addition, the individual significance of this permanent damage is important for the Compensation for pain and sufferingbecause, for example, a patient who was a roofer before the injury and who has been unable to perform physical work since the fracture due to severe pain in the elbow joint is more likely to receive compensation for pain and suffering than a patient who works in an office and has limited mobility Elbow can still do his job. Among other things, it depends on the extent of the occupational restrictions that the patient experiences as a result of his injury. In principle, permanent damage caused by a Radial head fracture There is a right to compensation for pain and suffering, but this must be considered and determined in the individual case of the patient.

Radial head fracture in the child

Children can also fracture the radial head. This happens most often in the context of sports or traffic accidents. As with adults, an X-ray is taken to confirm the diagnosis. The therapeutic treatment is selected depending on the extent of the injury and the stability of the fracture. Stable fractures that are still in an anatomically correct position can often be treated conservatively, open fractures with pronounced accompanying injuries or unstable fractures must be surgically treated and screwed. This is followed by physiotherapy treatment to help the children regain their original range of motion.

Read more on the topic: Broken arm in the child