Radial Head and Neck Fractures

Introduction

As everyone can apprehend, the radius is the bone, along with the ulnar, which makes the forearm. The radius runs from the base of the thumb, wrist, and elbow. At the elbow region, the radial bone holds two parts: the radial head and the radial neck. The radial head is the radial bone’s bulbous end, where it reaches the elbow. Fractures in these aspects are common, resulting from falls and assault with an outstretched arm or direct fall on the radial region of the elbow.

Radial head and neck fractures make up nearly 30 percent of elbow fractures. In addition, they amount to 1.7 to 5.4 percent of all adult fractures. The findings from studies state that radial head and neck fractures hold equal gender prevalence, while other study underlines the ratio of two to one with male predominance. Moreover, fractures in men occur almost seven years prior to fractures in women. Radial neck fractures are most common in cases of children while less in adults. Radial head fractures are commonly seen through the stages of adulthood, with the mean time between 30 and 40 years of age.

What Is the Functional Anatomy of the Radial Head and Neck?

The radius bone is one of the two bones of the forearm. In contrast, the other one is the ulna bone. The radius bone is present on the lateral aspect of the forearm, extending from the thumb. The radius is responsible for the hand and forearm movements since it allows pronation (palm downward), supination (palm upward), adduction (a movement of the joint to move a part of the body toward the midline in one plane), abduction (a movement of the joint to move a part of the body away from the midline), extension (straightening a joint that increases the angle between body parts), and flexion (movement decreasing an angle between the body parts) associated with the elbow and wrist. Moreover, the radial head and neck form most of the radius bone. The radial head is the proximal end of the bone, and it is the disk-shaped component with a flattened end that articulates with the humerus bone. The radial neck is the constricting part next to the radial head region.

What Are the Symptoms Associated With Radial Head and Neck Fractures?

The radial head and neck fractures result from the fall on outstretched hands. The fracture may involve the ulna or other bones in proximity. The radial head and neck fractures present with the following symptoms.

• Pain on the external aspects of the elbow.

• Swelling of the elbow joint.

• Inability or impairment in turning the forearm.

• Hard time bending or stretching the elbow due to pain.

• Limited range of motion.

• Bruising can occur due to internal bleeding.

• The affected area can be tender to touch.

• Stiffness in the elbow joint.

• Restriction of movements as a means of extreme pain or mechanical obstruction.

Additional symptoms, such as the sensation of instability and visible deformity of the elbow joint, can be seen in severe cases. Radial head and neck fractures do not typically have a deformity. Nevertheless, there might be injuries associated with the fracture, including ulna shaft fracture and elbow dislocation.

How Are Radial Fractures Classified?

Proximal radial fractures possess a wide range of classifications. The classification is primarily based on the following.

• Anatomical locations such as physical and metaphyseal sites.

• Ligamentous or bony.

• Presence of associated injuries concerning forearm and elbow.

• Existence of dislocation or relocation of the elbow joint.

• Degrees of displacement.

What Are the Potential Complications Associated With Radial Fractures?

Various complications might result following the injuries concerning the radial head and neck.

• Forearm rotation stiffness.

• Heterotopic ossification is known for excess bone formation around the areas of the actual fracture site. This, in turn, leads to a mechanical block in the system.

• Physeal arrest (a condition in which complete cessation of the skeletally immature bone occurs due to some disturbance in the physeal bone plate) completely might lead to angulation of the bone and joint.

• Avascular necrosis (bone tissue death due to cessation of blood supply) in the radial head region. This complication is seen with an initial displacement or deferred fixation.

• Elbow stiffness.

• Radial neck malunion.

What Are the Treatment Options for Radial Head and Neck Fractures?

The management is based on the type of fractures, the severity of the injury, the involvement of surrounding structures, several determinants, and the overall patient’s health. Medical healthcare professionals recommend radiographic investigations, including a computed tomography (CT) scan of the elbow. They will prescribe effective orthopedic intervention following appropriate diagnosis and radiographic interpretations.

• Reduction is not prescribed in cases of fractures with minimal isolation, angulation, and displacement. In this instance, the immobilization method is generally prescribed. So, the orthopedist treats the patient with an above-elbow black slab and bandages, securing it for about three weeks.

• Open or closed reduction is prescribed for other degrees of radial fractures. The reduction is performed by an orthopedic surgeon under general anesthesia and X-ray image intensification.

• Surgery concentrates and fixates the fractured parts by fixing or removing the broken and deteriorated bone fragments. In addition, it repairs and restores soft tissue damage.

• In severe radial fractures, radial head removal is prescribed in conjunction with the restoration by means of artificial plates. The function is then enhanced.

What Are the Important Considerations for Radial Head and Neck Fractures?

The initiation of early motion is the principle of intervention for radial head and radial neck fractures. The following considerations are to be taken into account since early intervention is the key to early healing and recovery.

• A fracture with the involvement of radial head displacement is in need of a senior orthopedic consulting session on the same day.

• The features extending to the articular aspects require same-day orthopedic consultation.

• The management following non-displaced isolated radial neck fractures is primarily according to the angulation. Hence, reduction is not needed in fractures that are less than or equal to 30 degrees.

• Fractures with angulation higher than 30 degrees generally require reduction.

• The degree of angulation may modify with associated injuries.

Conclusion:

Radial head and neck fractures, ranging from mild to severe, are considered spectrum fractures. Some fractures usually require simple management by knowledgeable and skilled physicians. In others with complex fractures, orthopedic referral, and orthopedic intervention may be required. Only a few get worse with the displacement and injuries to the proximal parts of the elbows. So, in conclusion, the prognosis is typically favorable with early attention and care. The management of radial head and radial neck fractures is primarily achieved by proper immobilization and optimizing the use of reduction treatment if needed.