Proximal radial fracture (summary)

This is a basic article for medical students and other non-radiologists

Proximal radial fractures are the commonest elbow injury in adult patients and the injury most likely to cause an elbow joint effusion. Radial head and neck fractures are often subtle and may be occult on initial imaging.

Reference article

This is a summary article. For more information, you can read a more in-depth reference articles radial head and radial neck fracture.

Summary

• anatomy
  • normal radius
• epidemiology
  • most between 20 and 65 years
  • 2:1 female:male ratio
  • older female patients predisposed due to reduced bone density
• presentation
  • fall onto an outstretched hand with hyperextended elbow
  • pain and reduced range of motion
• pathophysiology
  • almost always secondary to trauma
  • force required is greater in younger patients
  • force exerted down the radius impacts the humeral condyles
  • radial head and neck are the weakest points and liable to fracture
• investigation
  • elbow radiograph (AP and lateral)
  • in complex radial head fracture, CT can help to classify the fracture
• treatment
  • immobilization in cast for the majority of injuries
  • internal fixation may be required
  • reduced range of motion may occur, especially if intra-articular

Radiographic features

In most cases, all that is required for the diagnosis, treatment and followup is an elbow x-ray which is composed of an AP and lateral view.

Plain radiograph

The first thing to look for on an elbow x-ray is an elbow joint effusion. This will be visible as elevation of the posterior fat pad. If there is an elbow effusion in an adult patient, it is likely that the cause is a radial head or neck fracture.

Look carefully along the cortical surface of the radial head and neck on both views and look particularly carefully at the head on the AP view.