Radial head fractures--an update.
Radial head fractures are the most common fractures occurring around the elbow. Although radial head fractures can occur in isolation, associated fractures and ligament injuries are common. Assembling the clinical presentation, physical examination, and imaging into an effective treatment plan can be challenging. The characteristics of the radial head fracture influence the technique used to optimize the outcome. Fragment number, displacement, impaction, and bone quality are considered when deciding between early motion, fragment excision, and radial head excision, repair, or replacement. Isolated, minimally displaced fractures without evidence of mechanical block can be treated nonsurgically with early active range of motion (ROM). Partial, displaced radial head fractures without evidence of mechanical block can be treated either nonsurgically or with open reduction internal fixation (ORIF), as current evidence does not prove superiority of either strategy. For displaced fractures with greater than 3 fragments, radial head replacement is recommended. Radial head arthroplasty may be preferred over tenuous fracture fixation in the setting of associated ligament injuries when maintenance of joint stability could be compromised by ineffective fracture fixation.
Pike
Jeffrey M
JM
Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada.
Athwal
George S
GS
Faber
Kenneth J
KJ
King
Graham J W
GJ
D000465:Algorithms; D017885:Collateral Ligaments / Q000293:injuries / Q000601:surgery; D003952:Diagnostic Imaging; D004551:Elbow Joint / Q000601:surgery; D005593:Fracture Fixation, Internal; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D007594:Joint Loose Bodies / Q000601:surgery; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D011183:Postoperative Complications; D019736:Prostheses and Implants; D011885:Radius Fractures / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D000092464:Elbow Injuries