Repair of Radial Head Fracture with replacement

Radial Head Fractures

The forearm has two long bones, the ulna and the radius.  The upper end of the ulan forms the olecranon, which is covered on a different page.  The upper par tof the radius form a little spool that allows rotation of the forearm at the elbow. Fractures of the radial head occur during falls in which the person tries to catch themselves by landing on an outstretched arm. They range from non-dsplaced cracks in the bone, to widely displaced fractures with an unstable joint.

Diagram showing rotation of the forearm through the radial head

 Most of these are treated with non-operative management that consists of a sling and or splint for the first 7-10 days and then gradual resumption of activities after the splint is removed.  Physical therapy is not typically needed as the vast majority of patients regain motion and function spontaneously over a 6-8 week period.

X-rays showing a comminuted radial head fracture

 In fractures which are displaced or unstable, I generally recommend one of two procedures: Open reduction and internal fixation or  radial head arthroplasty. If the fragments are large and the bone quality is good, I will often try to repair the fracture with small plates and screws. This surgery takes about 1-1.5 hours and is done as an outpatient.  I protect the repair for about 3-4 weeks in a splint or a cast to minimize the motion at the repair site.

Intra-operative, post operative  photo of a repaired radial head fracture

 Radial head arthroplasty involves replacing the fractured radial head with an artificial radial head, similar to the procedure for total hip replacement, in which a metal radial head is implanted.  This procedure takes approximately one hour and is done as an outpatient procedure, similar to repair. After surgery, the arm is placed in a soft case for about 2 weeks and then therapy is started to regain function.  Most patients recover fully with only minor limitation of function, but full recovery can take 3-6 months. 

Radial head arthroplasty components and x-ray after replacement

The primary long term problem that develops after surgery is stiffness of the elbow joint.  Most patients are able to bend fairly well but getting the elbow completely straight is often troublesome and I tell patients to expect to loose 5-10 degrees of extension (ability to completely straighten the arm) once they are done healing. Unfortunately, surgical release of the scar tissue around the elbow often makes the problem worse, so I discourage this approach in all but the most severe contractures.  To help combat stiffness, I will often perscribe a Dynasplint (a dynamic splint the patient uses on their own typically in the evenings) as an adjunct to physical therapy.  This can help patients regain motion more quickly.  I have included a photo of a dynasplint below and a link to their website.  In general, I have found this device to be quite useful in regaining elbow motion.

Dynasplint Link

Examples of Elbow Dynasplints

For more information about surgery, what to expect after surgery and some useful tips and FAQ's, I recommend looking at my post-op elbow instruction sheet (link below).  It contains a lot of information about surgery, timing, what's not and what's not.  If you're scheduled to have surgery on your elbow, you should read this

Elbow Surgery Post op Instructions