What is the Standard Medical Treatment for a Fractured Radial Head?

Radial Head Fractures: Treatment, Recovery, and Risks Explained

A fractured radial head is a common injury, especially after a fall onto an outstretched hand. This injury involves a fracture in the upper part of the radius bone near the elbow joint. Symptoms typically include pain, swelling, and reduced motion of the arm. 

Based on the severity and nature of the fracture observed on imaging, treatment ranges from conservative measures for minor fractures, which include immobilization and physiotherapy, to surgical restoration of elbow function in severe cases. 

Read ahead to find the standard medical treatment for a fractured radial head.

What is the Standard Treatment Approach for a Fractured Radial Head?

The following is the standard treatment approach for treating a fractured radial head:

1. Initial Assessment and Classification

A suspected fracture of the radial head must be handled with care. The clinical evaluation includes lateral pain at the elbow, swelling, restricted arm flexion or extension, and impaired forearm rotation, which are typical presenting signs.

Radiography—often including AP and lateral elbow X-rays—confirms the diagnosis. CT scans are sometimes used for precise imaging.
The treatment is based on the Mason classification system:

• Type I: Non-displaced or minimally displaced fractures
• Type II: Displaced fractures with over 2 mm of displacement
•  Type III: Comminuted (multi-fragment) fracture
•   Type IV: Fracture with associated elbow dislocation

2. Non-Surgical Treatments

Non-surgical treatment is ideal for most Type I fractures and certain Type II fractures, without mechanical block to motion or elbow instability.

3. Emergency Care

Emergency care involves the following: 

• Immobilization: A posterior splint or sling immobilizes the elbow to relieve discomfort initially. Immobilization is typically short-term (less than one week) to prevent stiffness.
• Pain Management: Non-steroidal anti-inflammatory agents (NSAIDS), such as ibuprofen, are used to manage pain and reduce inflammation.

4. Early Mobilization

Progressive elbow movement is encouraged from days 3 to 7, including:

• Physical Therapy: Directed therapy improves range of motion (ROM), prevents stiffness, and enhances joint function.
• Home Exercises: Gentle movements, such as elbow flexion, forearm rotation, and extension, are recommended for gentle exercise.

Prolonged immobilization beyond 1–2 weeks should be avoided, as it significantly increases the risk of elbow stiffness and poor functional outcomes.

5. Surgical Treatments

Surgery is utilized for Type II (highly displaced), Type III, and Type IV fractures, particularly when joint stability is compromised or when there is a block to movement due to fragments.

6. Open Reduction and Internal Fixation (ORIF)

Indications:

• Displacement greater than 2 mm
• Mechanical blockage of elbow motion
•  Associated ligament injuries causing instability

Procedure

•  The surgeon moves the bone fragments through an open reduction and realignment procedure.
• Screws, mini-plates, or bioabsorbable pins are utilized to stabilize the fragments (internal fixation) rigidly.

Postoperative care involves early motion exercises as tolerated.

7. Radial Head Excision

Indications:

•  Severely comminuted fractures that cannot be corrected.
• Radial head excision may be considered in select low-demand elderly patients only when elbow stability is preserved and there are no associated ligamentous injuries.

Procedure:

• Surgical excision of the radial head.

Complications include loss of elbow stability, especially in active, young patients. Therefore, an excision is less suitable for patients in high demand.

8. Radial Head Arthroplasty (Replacement)

Indications:

•  Extremely comminuted fractures that are unstable.
•  Fractures with associated ligament injuries or elbow dislocation.

Procedure:

•  The damaged radial head is excised and replaced with a metal prosthesis.

Advantages:

•  Ensures elbow stability.
•  Permits early motion.
• Reduces long-term complications such as arthritis.

Rehabilitation after arthroplasty typically begins within days of the procedure to maintain flexibility.

What is the Rehabilitation Process After the Radial Head Fracture Treatment?

Rehabilitation plays a crucial role in optimizing functional outcomes after any mode of treatment. It often includes the following stages: 

1. Early Stage (0–2 weeks)

• Gentle elbow movements that cause no pain are encouraged.
• Pendulum exercises and wrist range-of-motion exercises to prevent stiffness.

2. Intermediate Stage (2–6 weeks)

• Gradual progression to active and passive range of motion exercises.
• Begin light strengthening exercises for the forearm, elbow, and shoulder muscles.

3. Late Stage (6–12 weeks)

• Introduce resistance training along with increased functional activities.
• Returning to heavy lifting, contact sports, or strenuous work is typically postponed until recovery is complete, which usually takes 3 to 6 months.

What are the Possible Complications Following a Fractured Radial Head Treatment?

Even when treatment is effective, complications may sometimes arise, such as:

• Stiffness: Most frequent, particularly with prolonged immobilization.  
• Post-Traumatic Arthritis: Occurs due to damage to the cartilage at the time of injury.  
• Non-union or Malunion: Rare but can happen if healing is suboptimal.  
• Elbow Instability: This condition is especially prevalent in high-energy fractures or following radial head excision without stabilization.  
• Hardware Irritation: Results from screws or plates that may need to be removed in the future.

Standard medical treatments for a fractured radial head typically include immobilization with a sling, physical therapy, and, in some cases, surgical intervention. Non-displaced fractures are often managed conservatively, while severe breaks may need fixation or replacement.

Reader Information: This article is intended for general informational and educational purposes only. Diagnosis and treatment of a radial head fracture depend on multiple factors, including fracture type, associated injuries, patient age, activity level, and overall health. Readers should not rely on this content as a substitute for professional medical consultation and should seek advice from a qualified healthcare provider or orthopedic specialist for personalized evaluation and treatment recommendations.

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