Elbow Fracture (Radial Head)

Description

A radial head elbow fracture is a broken bone in the elbow involving the disk-shaped radial head. This break may be complete or incomplete.

Common signs and symptoms

• Severe elbow and arm pain at the time of injury

• Tenderness, swelling, and later bruising of the elbow

• Visible deformity if the fracture is complete and bone fragments separate enough to distort normal body contours (rare)

• Numbness, coldness, or paralysis in the elbow, forearm, or hand from pressure on the blood vessels or nerves (rare)

Causes

• Usually, an indirect stress from falling on an outstretched hand

• A direct blow or force to the elbow

• Twisting injury to the elbow

Factors that increase risk

• Contact sports, such as football and rugby

• Sports in which falling is likely (skating, basketball)

• Age under 12 years or over 60

• History of bone or joint disease

• Poor physical conditioning (strength, flexibility)

Preventive measures

• Appropriately warm up and stretch before practice or competition.

• Maintain a conditioning routine that includes cardiovascular fitness, elbow and arm strength, flexibility, and endurance training.

• Wear proper protective equipment, such as elbow pads and wrist splints, and ensure a correct fit.

Expected outcome

With appropriate treatment and normal alignment of the bones, healing can be expected in 6 to 8 weeks in adults and 4 to 6 weeks in children. Surgery may be necessary to realign fractures that are displaced.

Possible complications

• Nonunion (fracture does not heal)

• Malunion (fracture heals in a bad position)

• Chronic pain, stiffness, loss of motion, or swelling of the elbow

• Calcification of the soft tissues about the elbow (heterotopic ossification)

• Excessive bleeding in the elbow or at the fracture site, causing pressure and injury to nerves and blood vessels (rare)

• Unstable or arthritic joint following repeated injury, misalignment of the joint surface, or delayed treatment

• Arrest of normal bone growth in children

• Atrophy, weakness, stiffness, numbness, and poor control of the hand resulting from injury to blood vessels, nerves, cartilage, muscle, ligaments, and fascia

General treatment considerations

If the bones are in an appropriate position, the initial treatment consists of ice and elevation of the injured elbow at or above heart level to reduce swelling, and medications are prescribed to help relieve pain. Immobilization by splinting, casting, or bracing for 1 or 2 weeks may be recommended to protect the radial head while it heals and pain subsides. A sling may afford comfort. Large fractures that are displaced (not in appropriate alignment) may require surgery to restore and maintain the joint’s normal position. Surgery usually includes repositioning the bone and holding it in place with plates, screws, or pins or removing the broken radial head. After injury, especially with prolonged immobilization (with or without surgery), the elbow may be stiff. Stretching and strengthening of the injured and weakened joint and surrounding muscles are usually necessary because of the injury and the immobilization. Exercises may be performed with the assistance of a physical therapist or athletic trainer, and early resumption of normal elbow range of motion is important in preventing or reducing the loss of motion that usually accompanies this injury.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Strong pain relievers may be prescribed as necessary. Use these only as directed, and take only as much as you need.

Figure 1

From Scuderi GR, McCann PD, Bruno PJ: Sports medicine: principles of primary care, St Louis, 1997, Mosby, p 259.

Cold therapy

Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed. Use ice packs or an ice massage.

When to call your doctor

• Pain, tenderness, or swelling worsens despite treatment.

• You experience pain, numbness, or coldness in the hand.

• A blue, gray, or dusky color appears in the fingernails.

• Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Range of Motion and Stretching Exercises

Elbow Fracture (Radial Head)

These are some of the initial exercises you may start your rehabilitation program with after your cast or brace has been removed and you are allowed to move your elbow. Do these exercises as instructed until you see your physician, physical therapist, or athletic trainer again or your symptoms resolve. Please remember:

• Flexible tissue is more tolerant of the stresses placed on it during activities.

• Each stretch should be held for 20 to 30 seconds.

• A gentle stretching sensation should be felt.

Range of motion supination

1. Stand or sit with your elbow bent to 90 degrees.

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