A fall on an outstretched hand that produces lateral elbow pain and difficulty rotating the forearm — that's a radial head fracture until proven otherwise. Dr. R. David Graham at JOI applies Mason classification to determine treatment: splint, ORIF, or radial head replacement. The lateral ligament is assessed at every operation.
The radial head is not just an elbow bone — it is a forearm axis stabilizer. Excision without replacement in the setting of interosseous membrane disruption causes proximal radius migration and DRUJ arthritis. Dr. Graham assesses forearm stability on every radial head fracture.
Understanding the Fracture
The radial head sits at the lateral elbow where the radius articulates with the capitellum of the humerus and the proximal ulna. It is the primary bony stabilizer against valgus stress and axial load at the elbow, and it also plays a critical role in forearm rotation. When a fall transmits force up through an outstretched hand, the radial head is driven into the capitellum — producing a fracture that ranges from a hairline crack to complete comminution.
The critical assessment beyond the fracture itself: the lateral ulnar collateral ligament (LUCL), which originates at the lateral epicondyle adjacent to the radial head, is frequently injured in the same event. When both the radial head fracture and LUCL tear occur together — an elbow fracture-dislocation — both must be addressed or the elbow will remain unstable after fracture treatment. Dr. Graham assesses elbow stability intraoperatively on every radial head case.
A second critical assessment: the interosseous membrane of the forearm. If the interosseous membrane is also disrupted (Essex-Lopresti injury), the radial head cannot simply be excised — it must be replaced, or the radius will migrate proximally and destroy the distal radioulnar joint. Forearm axis stability is assessed clinically and radiographically on every radial head fracture.
The radial head has three roles: (1) elbow joint stabilizer against valgus and axial load; (2) pivot point for forearm pronation and supination; (3) proximal stabilizer of the forearm axis via the interosseous membrane. Treatment must account for all three when the fracture is significant.
Treatment by Mason Type
Mason classification drives the treatment decision. The goal in all types: restore elbow stability and forearm rotation as quickly as possible.
| Mason Type | Fracture Pattern | Dr. Graham's Treatment |
|---|---|---|
| Type I | Non-displaced or minimally displaced radial head fracture. Articular incongruity <2mm. No block to forearm rotation on examination. | Posterior splint 1–2 weeks, then early motion. Early range of motion is the priority — immobilization beyond 2 weeks risks stiffness. No surgery. Follow-up X-rays at 1 week to confirm no displacement. |
| Type II | Partial articular fracture, displaced >2mm. Involves portion of the radial head articular surface. Mechanical block to rotation may be present. | ORIF with mini-fragment screws or headless compression screws. Displaced articular fragments are reduced and fixed. Goal: restore congruent articular surface and allow early motion. Screws countersunk below articular cartilage surface. |
| Type III | Comminuted fracture involving the entire radial head. Fracture is not reconstructable — too many fragments, poor bone quality, or comminution that precludes stable fixation. | Radial head replacement. A metallic radial head prosthesis replaces the comminuted native head. Maintains the radial head's role as valgus and axial stabilizer. Simple excision without replacement is avoided — risk of proximal radius migration and Essex-Lopresti sequelae. |
| + LUCL | Any Mason type associated with elbow dislocation or confirmed LUCL disruption on stress examination under anesthesia. | LUCL repair at same surgical setting after fracture fixation or replacement. Elbow stability confirmed under fluoroscopy before closure. See LUCL Tear page for full repair detail. |
Recovery
Type I: splint 1–2 weeks then begin motion. Type II/III post-op: splint for wound healing, then motion begins within the first week to prevent stiffness.
Formal therapy for elbow flexion-extension and forearm rotation. Elbow stiffness after radial head fracture is common — early, aggressive range of motion is the priority treatment.
Progressive grip and elbow strengthening. Return to light manual work. Radiographs confirm fracture healing or implant position for replacement cases.
Full return to work and activity at 3–4 months for most fracture types. Type III replacement cases may take slightly longer for complete strength restoration.
"Dr. Graham fixed my elbow fracture and told me exactly what to expect. He started me in therapy the week after surgery and I got my full range of motion back."
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Radial head fractures are among the most common elbow fractures — but the associated injuries that accompany them (LUCL tears, Essex-Lopresti) are frequently missed on initial evaluation. Dr. Graham assesses the complete picture: fracture pattern, elbow stability, and forearm axis integrity. Walk-ins welcome via JOI Now for acute elbow injuries on clinic days.
Walk-ins welcome via JOI Now for acute elbow injuries.