Im 30 year old. At 20th October (last saturday) I fell during running, and i got radial head fracture. As im reading about such injuries im becoming a bit scared, as they are rather serious, often connected with surgery and problems with regaining full functionality of arm. A doctor in hospital was wondering if this fracture isnt with misplace of bone, but he decided bone will heal itself without surgery. I got a splint for 6 weeks.
You have a nondisplaced radial head fracture. This would be classified as a Mason Type I fracture. These fractures do the best with nonoperative treatment.
If there is any concern about radial head fractures, the best study would be a CT scan. Also, a thorough physical examination is needed, to make sure that there is no block to full range of motion (especially pronation and supination). If necessary, if the patient cannot tolerate the examination, often the hemarthrosis (blood inside the joint) is aspirated and the joint is infiltrated with lidocaine/marcaine (local anesthetic). The examination also has to include palpation of the DRUJ (distal radioulnar joint) and the interosseous membrane (to rule out the possibility of an Essex-Lopresti injury). But, the chance of an ELI is extremely low in a nondisplaced fracture.
But, from your x-rays, there is essentially a crack in the lateral lip of the radial head and it is not displaced. As long as it stays there, it will heal up very nicely.
However, six weeks is a very long time to immobilize an elbow. This length of immobilization will cause a significant amount of stiffness and loss of range of motion. The usual recommendation for treatment of stable Type I fractures, which involve less than a third of the articular surface (your fracture) is early mobilization. In other words, a light splint for a couple of days, followed by a sling and the beginning of range of motion. No heavy lifting or weight bearing on the hands for six weeks.
In Type I fractures which involve more than a third of the articular surface, in active young patients, the recommendation is to immobilize the elbow for no more than two weeks, followed by 7-10 days of protected range of motion, then the immobilization is discontinued and the patient allowed full range of motion as tolerated. Again, no heavy lifting for six weeks.
(The above is as per: “Skeletal Trauma: Basic Management and Reconstruction”; by Browner, Jupiter, Levine, and Trafton.)
So, you might want to speak with an orthopedic surgeon or hand surgeon for advice on how long to immobilize your elbow. Six weeks of immobilization is a “knee jerk” length often used by emergency room physicians or physicians who are not used to treating specific orthopedic injuries. Again, immobilizing an elbow for six weeks will result in a very stiff elbow and probably some loss of motion (possibly permanently).
You are now about a week out from your injury, so if you have been immobilized for this amount of time, it is probably time to start range of motion. But, again, if you are concerned about how you are being treated, see an orthopedic surgeon or hand surgeon.
Huge thanks for answer. It was really helpful.
I went to doctor and he said 2 more weeks in splint, and then ill get splint taken off and have to start exercisig arm, though bones wont be fully healed yet. He said 6 weeks in splint means not functional elbow almost for sure.
I have other concern and somehow i forgot to ask about it when having a visit at doctor.
Lately i feel pain near wrist, like at the begginning of thumb (from wrist side) or at wrist itself. It pains when im trying to rotate softly a wrist or when im tensing the thumb.
It is very concerning that you might have a scaphoid fracture or possibly an injury to the scapholunate ligament.
Where your wrist hurts, at the base of the thumb, is called the "anatomic snuffbox". When a patient has that a FOOSH injury (fall on outstretched hand) and has pain in that area, it is a scaphoid fracture till proven otherwise.
It is very difficult to see some scaphoid fractures on just a PA and lateral forearm film. It better look at the scaphoid bone, a set of wrists films is needed, or at least a PA of the wrist in full ulnar deviation is needed. The ulnar deviation film will put the scaphoid in a position where it is fully extended, and as such, any fractures should show up.
So, if you are still tender in the snuffbox, you should probably get that looked at. A good examination would be able to determine if the extra x-ray is necessary.
If is very possible to have both a radial head fracture and a scaphoid fracture.
23 days passed since my injury. I was in splint and i felt its getting better. I could tense a fist with no pain and also move my arm without pain.
As it was set, i went today to doctor, because i was about to have splint taken off to start exercising an elbow. It was other doctor than before, rather unpleasant guy. We made fresh x-ray and he said splint goes off, but arm is not ready for exercises yet. He said i must wear sling untill saturday, so next 5 days, and then start an exercise with touching my forehead.
Well, i dont move that arm, i dont twist or turn. But the pain is heavier, or id say once it became very heavy. Now im unable to tense a fist with such power as earlier when i had splint. I feel its very sensible now and I cant imagine ill do exercises with it in 5 days.
Im furious because im afraid doctor made mistake and my healing process went backward. At the moment i plan not to move arm at all and take painkillers (diclophenacum natricum).
Then in 5 days im going to try excersise. But, I really would love to see an advice of someone who knows about injuries because i dont know if to spent money to see another doctor as soon as possible or not...
Hosever, the longer you wait to move the elbow, the stiffer it will get. This is why most of the time, Mason I radial head fractures are started moving as soon as possible (we usually start them no later than two weeks after injury).
But, that is nether here no there now. You have been immobilized a very long time and you are going to be extrememely stiff. It is going to take a lot of effort, work, and pain to get the elbow moving now.
You will find that if you warm up the elbow with some hot packs before you do your exercises, the tissues will be more pliable and stretchable.
You might also find that if you can get into a pool for some therapy it will help. The buoyancy of the water helps to support the arm, making the exercises a lot easier.
But, you do have a long road ahead of you, in terms of therapy. Continue to make a fist and work your fingers and wrist. And, get ready for the therapy to begin on your elbow. You do not want to delay it much longer.
Thanks. So pain is normal. Last quick question. The pain isnt only at elbow, but whole forearm, from wrist to elbow.
The wrist concerns i mentioned in earlier post were looked at by doctor on X-rays and he said no bone is fractured at wrist.
That is great that you do not have a scaphoid fracture.
As to the discomfort, yes, it is usual for the joint to be very stiff and sore after being immobilized for a while. It is not "normal", but it is very common.
The muscles which move the fingers and wrist are located up in the proximal forearm. When you move the wrist, you have to stabilize the elbow. Now that you do not have the elbow immobilized, your own muscles have to do that job. This will cause you some discomfort, as you have not had to use those muscles in a while.
But, again, it is important to keep the fingers and wrist moving so that they do not also get stiff. It is going to cause some soreness in the forearm and elbow, but it is important.
If you can start to wriggle the elbow a little in the splint, that will also get you started on your road to therapy. You are going to have to start moving the elbow some time. And, it is going to be sore.
Here I am. 7 months after injury. My arm is fully functional. Sometimes it makes crack sound:). I need to tell you that Your advices made big difference, mentally and offcourse physically. I am really thankful.
At my country's websites You cant get such support.
This post was extremely helpful, but I still have questions about how long the pain should last. I understand the stiffness and soreness, but I am having a lot of dull throbbing pain within the upper forearm along with occasional sharp pains.
It's been about two weeks since initial injury, won't see orthopedist for another few days. They gave me a full arm splint. I wore it for about a week straight (except to shower), but it was molded slightly wrong and was causing more than it was alleviating. Now I'm just using a combination of a soft elbow brace and ace bandage (with a sling if really hurting), and avoiding any motions that cause extreme pain. I am slowly beginning to have a better range of motion and more forearm strength; for example I can finally grip and hold objects that are extremely light such as my cell phone or a glass (could not initially). And if its a motion that involves more use of my bicep (versus tricep) then I can handle a little more weight. From what I've read this is pretty good and normal progress.
But as I mentioned at the beginning, I am really concerned about the amount of pain I'm still in. Sometimes its very minimal, but at others it is almost as bad as the initial injury. When it is hurting that bad I ice it and put it back in the splint and sling, other than I am not sure what to do. I will definitely bring this up when I finally get to see the specialist.
Thanks! I've never had a broken bone (other than my nose) and I'm almost thirty, so this is a new experience for me. Sprains, strains, and dislocations that's a different story... just about everything but my elbows. But this is a whole different kind of pain. So, I guess I'm just a bit paranoid since I haven't been able to get a definitive diagnosis and treatment regimen yet. Hopefully soon.
The treatment of radial head fractures depends upon what Type it is. These fractures are usually classified by the Mason categories.
Type I is a nondisplaced fracture of the radial head or neck.
Type II is a fracture which involves less than 30% of the radial head, but has more than 2mm of displacement.
Type III is divided into three subdivisions
- type A: fracture of the entire radial neck, with the head completely displaced from the shaft;
- type B: articular fracture involving the entire head, which consists of more than two large fragments; and each fragment is completely displaced from the shaft;
- type C: fracture with a tilted and impacted articular segment, which must be reduced; or an articular fragment displaced from the shaft.
Usually, Type I are treated nonoperatively and have an excellent prognosis.
Type II fractures can be treated nonoperatively, if there is no step off in the articular surface. But, many of these need to be surgically.
Type III fractures are all treated surgically.
Hopefully, you will receive a complete program for therapy for your elbow. It does take some time for the bone to heal (about six weeks), and then you have to regain your motion and strength. In Type I fractures we start range of motion as soon as possible. But, if you have a Type II, your surgeon may want to delay full range of motion until the fracture is “sticky”.
Hi I have a question, I have a Type 1 fracture of the radial head, injured it on June 30, the er splinted me for 2 1/2 days before the orthopedic surgeon took it off and had me in a sling for 2 weeks after that he said to only where sling if needed and had me do a few rotation excersies and he released me back to work on July 27 and I'm a hairstylist so I use my arms a lot. Since being back to work the pain has started to increase and I still don't have full movement back in the elbow area. Is this normal or am I making the injury worse? Will it ever go back to the way it was begore? I feel like the doctor I see doesn't give me answers when I ask questions and I get pushed aside because I don't have insurance. Thanks for any advice you may have,