Radial Head Fractures
By Danielle Campagne, MD, University of California, San Francisco
Reviewed/Revised Dec 2022
Symptoms and Signs | Diagnosis | Treatment | Key Points
Radial head fractures frequently result from a fall on an outstretched
arm and may be difficult to see on x-rays.
(See also Overview of Fractures.)
The radial head is palpated on the lateral elbow as a structure that rotates during pronation
and supination and that articulates with the lateral epicondyle. The lateral epicondyle and
radial head typically form an isosceles triangle with the olecranon. Joint effusions (common
with radial head fractures) may be palpable over this triangle.
Radial head fractures are more common among adults than children.
Symptoms and Signs of Radial Head Fractures
When the radial head is fractured, pain at the radial head is worse during supination, and
the radial head is tender. Swelling due to hemarthrosis is usually present. Passive motion of
the elbow may be limited. Capitellum fracture may occur simultaneously.
Diagnosis of Radial Head Fractures
Physical examination
X-rays
Anteroposterior, lateral, and oblique views are taken. But because x-rays may show only
indirect evidence of fracture, diagnosis relies heavily on physical examination.
Routine anteroposterior and lateral x-rays often do
not show the fracture but usually show a joint Radial Head Fracture
effusion, which is indicated by the presence of
abnormal fat pads on x-rays. Displacement of the
IMAGE
anterior fat pad may indicate joint effusion but is not
specific; visibility of the posterior fat pad on a true
lateral view is specific for joint effusion but not highly
sensitive. Patients with localized radial head
tenderness and effusion require oblique views (which
are more sensitive for fracture) or presumptive
treatment of a fracture.
The radiocapitellar line is a line through the
midshaft of the radius on a lateral x-ray of the elbow.
Normally, this line transects the middle of the DU CANE MEDICAL IMAGING
capitellum. Sometimes in children, the only sign of LTD/SCIENCE PHOTO LIBRARY
fracture on x-rays is displacement of this line.
Arthrocentesis may be done to remove blood from
the joint to help differentiate mechanical blockage of Lateral X-Ray of the
passive joint motion from restriction due to pain and Elbow
muscle spasm. Then, a local anesthetic is injected to
relieve pain. IMAGE
Stability is tested by applying stress to the elbow
medially and laterally and checking for laxity or
increased motion. If the joint does not move when
stress is applied, the fracture is stable and associated
ligaments are probably uninjured.
IMAGE COURTESY OF DANIELLE
CAMPAGNE, MD.
Pearls & Pitfalls
If the radial head is
tender and there is
clinical or radiographic
evidence of an elbow
effusion, treat
presumptively for radial
head fracture even if the
x-ray shows no fracture.
Anterior humeral line and
radiocapitellar line
Normally, the anterior
humeral line, which is drawn
along the anterior border of
the humerus on a lateral x-ray,
transects the middle of the
capitellum. If the line transects
none or only the anterior part
of the capitellum, a distal
humeral fracture with
posterior displacement may be
present.
The radiocapitellar line, which
is drawn through the midshaft
of the radius, normally bisects
the capitellum. If it does not,
an occult fracture should be
suspected.
Treatment of Radial Head Fractures
Usually a sling and range-of-motion exercises
Rarely surgical repair
Fractures with minimal displacement and no restriction of passive elbow motion or
instability can be treated with a sling, which can be applied for comfort with the elbow flexed
90°. Elbow range-of-motion exercises should be started as soon as patients can tolerate
them.
If the elbow is unstable or motion is mechanically blocked, fractures are treated surgically.
Key Points
The radial head is tender, and pain is worse during supination.
Take anteroposterior, lateral, and oblique x-rays, but because x-rays may
show only indirect evidence of fracture, physical examination is very
important in diagnosis.
If the radial head is tender and clinical or radiographic evidence suggests an
elbow effusion, treat presumptively for radial head fracture even if the x-ray
shows no fracture.
Distal Humeral Fractures Ulnar and Radial Shaft Fractures
