Radial Head Fracture

Presentation

A patient has fallen on an outstretched hand and has a normal, nonpainful shoulder, wrist, and hand; on careful examination, however, the patient has pain in the elbow joint. Swelling may be noted over the antecubital fossa, and the patient may be able to fully flex the elbow joint, but there is pain and decreased range of motion (ROM) on extension, supination, and pronation of the forearm. The patient will be unable to fully extend the elbow joint. Tenderness is greatest on palpation over the radial head. Radiographs may show a fracture of the head of the radius. Often, however, no fracture is visible, and the only radiographic signs are of an elbow effusion or hemarthrosis pushing the posterior fat pad out of the olecranon fossa and the anterior fat pad out of its normal position on the lateral view ( Fig. 125.1 ). In all radiographic views, a line down the center of the radius should point to the capitellum of the lateral condyle, ruling out a dislocation.