Radial head fracture

Anatomy: Why the radial head is so important

The radial head forms the upper joint part of the radius and articulates with the upper arm bone (capitulum humeri). It enables rotation of the forearm (pronation/supination) and contributes to the stability of the elbow.

• Joint partner: Radial head – capitulum, as well as contact with the annular ligament (Lig. annulare radii).
• Function: Power transmission from wrist to elbow, stabilization during rotational movements.
• Ligament apparatus: Lateral collateral ligament, annular ligament – ​​often involved in fall mechanisms.

An injury to the radial head can seriously disrupt the finely tuned interaction of movement and stability and is therefore more than a “small break”.

What is a radial head fracture? Classification according to Mason

A radial head fracture is a break in the head of the radius near the elbow joint. The classic classification is according to Mason (modified):

The classification helps with the treatment decision: stability, joint level and accompanying injuries are crucial.

Causes and risk factors

A typical mechanism is the fall onto the outstretched, slightly bent arm (FOOSH). The force is transferred to the elbow via the spoke; the head of the radius abuts the capitulum.

• Sports: cycling, skiing, inline skating, ball sports with risk of falling.
• Everyday life: stumbling, slippery floors, falling down stairs.
• Bone quality: Osteopenia/osteoporosis increases the risk of fractures.
• Concomitant injuries: Ligament injuries (LCL/MCL), Essex-Lopresti injury (interosseous membrane damage and DRUG instability), elbow dislocation.

The higher the energy of the trauma and the poorer the bone quality, the more likely complex fractures are.

Symptoms: How to recognize a radial head fracture

• Acute pain on the outside of the elbow (radial), increased with rotational movements.
• Swelling, tenderness, occasional bruising.
• restriction of movement; Blockage during extension or rotation of the forearm.
• Reduced strength when carrying/supporting.
• Rare: numbness/tingling (indication of nerve involvement).

Warning signs that should be clarified by a doctor immediately: severe misalignment, increasing pain at rest, sensory disturbances in the hand, paleness/coldness (circulatory problems) or visible joint misalignment.

First aid after a fall

• Immobilize in a comfortable position, keep your arm close to your body.
• Cool (wrapped in a cloth, 10–15 minutes), observe skin protection.
• Light compression only if tolerated.
• Elevation to reduce swelling.
• No forced movements, no attempts at self-reposition.

If there is significant misalignment, severe pain or neurological symptoms: go to the emergency room. Otherwise, have it checked by an orthopedist as soon as possible.

Diagnostics in practice

First, we take a detailed accident history, examine blood circulation, motor function, sensitivity and check ligament stability, as far as possible due to pain.

• X-ray in two planes plus special radiocapitellar image (Greenspan tangent).
• CT for complex, displaced or multi-fragmentary fractures for surgical planning.
• Ultrasound for effusion and soft tissue assessment; MRI only for special questions (e.g. ligament/IOM injury).
• Systematically assess accompanying injuries (dislocation, ligament injuries, Essex-Lopresti constellation).

The exact assessment of stability determines the therapy. It's not just the shape of the fracture that counts, but also whether there is a mechanical blockage.

Treatment: Conservative first if possible

Many radial head fractures (particularly Mason I and stable Mason II) can be safely treated without surgery. The aim is early, pain-adapted mobilization to prevent stiffness.

• Short-term immobilization: upper arm splint or bandage, usually 3-7 days, then gradual mobilization.
• Pain therapy: cooling, anti-inflammatory medication after consultation, local measures.
• Puncture/relief of a pronounced joint effusion can reduce pain (individual decision).
• Physiotherapy: Early functional exercise programs for flexion/extension and later pronation/supination.
• Stress: Everyday activity in a low-pain range, no lifting heavy loads for approx. 6 weeks.
• Thrombosis prophylaxis only in cases of prolonged immobilization or individual risk constellation.

We closely monitor the course and movement gain. Persistent mechanical blockages or increasing instability require reassessment.

Surgical procedures: when they make sense

Surgery is considered if the fracture is significantly displaced, the joint is blocked, concomitant injuries endanger stability or there is a dislocation (typically Mason II with blockage, III and IV). The decision is made individually, after imaging and clinical stability testing.

• Screw or plate osteosynthesis: Reconstruction of the articular surface with movable fragments.
• Radial head prosthesis: for multi-fragmentary fractures that cannot be reconstructed or for instability (e.g. Essex-Lopresti constellation).
• Arthroscopically assisted procedures: in selected cases for assessment/removal of small fragments.
• Resection of fragments: usually very conservative, as the radial head is an important stabilizer.

After a surgical procedure, early functional mobilization is also carried out as long as stability allows this. Tailored follow-up treatment is crucial for the result.

Follow-up treatment and rehabilitation

Follow-up treatment is a core part of therapy. The goal is to gain movement while protecting healing. The extent and pace depend on the type of fracture and stability (conservative or surgical).

• Work: office often possible after a few days; Depending on the load, manual work takes 6-12 weeks.
• Driving: if safe control of the vehicle is possible, usually after 1-2 weeks (check with a doctor).
• Physiotherapy: structured, with home exercises; The goal is symmetry and pain-free function.

Prognosis, possible complications

The outlook is good for stable fractures with early functional treatment. Individual factors such as fracture complexity, concomitant injuries and rehabilitation adherence influence the course.

• Elbow stiffness: the most common problem – early, guided mobilization prevents this.
• Pain/blocked movement due to step formation or free fragments.
• Heterotopic ossifications (ossifications in soft tissues): rare, especially after complex injuries.
• Pseudarthrosis/non-union: rarely on the radial head.
• Instability; Essex-Lopresti is at risk of forearm/wrist problems.
• Post-traumatic arthrosis due to joint incongruence.
• Nerve irritation or CRPS: rare, detect and treat early.

Realistic goals, close monitoring and a coordinated rehabilitation plan improve the results. We cannot seriously give any guarantees.

Prevention: This is how risks can be reduced

• Fall prevention: non-slip shoes, clear paths, use handrails.
• Protective equipment in sports: helmet, wrist/elbow pads in high-risk sports.
• Strength and coordination training to improve reactions.
• Bone health: osteoporosis check, calcium and vitamin D status, therapy if necessary.
• Technical training in sports, especially braking and rolling techniques.

When should you come to us?

• After a recent fall with elbow pain and swelling.
• If movements are blocked or rotational movements are extremely painful.
• If symptoms persist after a diagnosis has already been made – for a second opinion or rehabilitation optimization.
• After surgery for structured aftercare and functional restoration.

In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, you will receive evidence-based assessment and therapy. We rely on conservative procedures, and if an operation makes sense, we provide transparent advice and coordinate further care in an experienced network.

Expiry of your appointment

Together we decide on the next steps – seriously, without hasty interventions.

Compact knowledge: Frequently asked questions about the decision

• Not every step in the joint is automatically an indication for surgery - function and stability are crucial.
• Early mobilization is crucial, but only in a low-pain, safe area.
• Radial head resection is used very cautiously today - stability comes first.
• CT helps with complex fractures; overtreatment should be avoided.