A radial head fracture is a common elbow injury, often resulting from a fall onto an outstretched hand or elbow. This type of fracture affects the radial head or neck, the small round bone at the top of the radius. These fractures are common in athletes and active individuals, particularly in sports that involve falling, impact, or direct blows to the arm. So, how do you know if you have a radial head fracture of the elbow, and what do you do about it?    

Mechanism of Injury 

The most common mechanism is a fall onto an outstretched arm, where the force is transmitted up the forearm to the elbow joint. The radial head absorbs this force, leading to a fracture. Less commonly, direct blunt trauma to the elbow or high-impact sports injuries can also cause this type of fracture.

Symptoms 

  • Pain on the outer side of the elbow
  • Swelling and bruising on the outside of the elbow
  • Stiffness in elbow movements with restriction in bending and straightening 
  • Pain with forearm and wrist rotation 
  • Occasionally, the elbow has a clicking or locking sensation in more severe, displaced fractures.

How to Diagnose a Radial Head Fracture 

Clinical Examination

A sports medicine specialist will assess the mechanism of injury and presenting signs: 

  • Tenderness over the radial head (just below the lateral epicondyle of the humerus)
  • Limited forearm rotation (supination and pronation)
  • Pain with elbow extension and flexion
  • Swelling, including soft tissue and joint

Generally, we use X-rays to confirm whether the fracture is displaced. Sometimes, we use CT scans to view fracture displacement better. MRI can also confirm the diagnosis and rule out ligament or joint damage. 

X-ray revealing radial head fracture

Treatment 

Non-displaced or minimally displaced fractures: 

These fractures heal with conservative management, such as short-term use of an arm sling, painkillers such as paracetamol/codeine, and early gentle range-of-motion exercises within a few days of injury. 

After a week, we perform a repeat X-ray to ensure the fracture has not moved. Then, patients start formal physiotherapy to regain range of motion and strength. 

Surgical Treatment 

Usually, surgery is required when:

  • The fracture of the head is displaced (greater than 2mm) 
  • Radial neck fracture with a tilt of the head of >15 degrees
  • Bone fragments or loose bodies block the elbow movement. 
  • There is an associated dislocation or ligament injury (complete radial collateral ligament tear)

We treat most cases with screws or a plate fixing the radial head in place. In severe comminuted fractures, radial head excision or implant insertion is sometimes used.  

Other Frequently Asked Questions:

What to Do About Stiffness After a Radial Head Fracture?

Stiffness is common, especially if patients immobilise the elbow for too long. To improve mobility, we recommend the following: 

  • Gentle stretching and mobility exercises (under the guidance of a physiotherapist).
  • Passive range-of-motion exercises if movement is significantly limited.
  • Hydrotherapy or heat therapy to reduce stiffness.

Do You Need a Cast for a Radial Head Fracture?

A full cast is not usually necessary. We manage most fractures with:

  • A sling or removable splint for a few days.
  • Early movement exercises to prevent stiffness.

Casts are only used for associated ligament damage requiring immobilisation. 

Which Radial Head Fractures Require Surgery?

Patients require surgery for:

  • Displaced head fractures of greater than 2mm.
  • Displaced radial neck fractures with an abnormal head tilt of greater than 15 degrees
  • Comminuted fractures where the bone is shattered.
  • Elbow dislocations with fractures needing stabilisation
  • Mechanical locking after conservative treatment.

How long do radial head fractures take to heal? 

Generally, patients need 2-3 months for complete healing. However, some cases cause increased stiffness, which requires more prolonged recovery. You can return to heavy lifting in 6-12 weeks and sports in about 12 weeks or until your range of motion has returned to normal. 

Final word from Sportdoctorlondon about Radial head fractures

Radial head fractures are common elbow injuries, particularly in active individuals and athletes. Early diagnosis and appropriate management are crucial for preventing long-term stiffness and functional loss. Most cases only need conservative management with early movement to avoid stiffness. Surgery is required only for a minority of cases with a displaced fracture or associated ligament damage.  

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