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Radial Head Fracture

Hello

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.

Here is my x-ray picture:

http://i42.servimg.com/u/f42/15/52/06/85/z aaman10.jpg



Doctor was rly young, like right after finishing University, so im quite anxious is the splint enough.

How serious my injury looks like?
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First Helper User Profile Gaelic
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replied October 25th, 2012
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Gisohtin,

Sorry about your injury,

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.

Good luck.
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replied October 30th, 2012
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.

Pain is somewhere here (thats not my hand):

http://i42.servimg.com/u/f42/15/52/06/85/i mages10.jpg

I dont remember having pain or swelling there at the time of my accident. Im wondering is it normal that pain appears there while having stiff arm or maybe there is something damaged there too.
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replied October 31st, 2012
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replied October 31st, 2012
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Gisohtin,

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.

Good luck.
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replied November 12th, 2012
Hi again.

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...
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replied November 12th, 2012
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Gisohtin,

Sorry about your problems.

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.

Good luck.
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replied November 13th, 2012
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.
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replied November 13th, 2012
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Gisohtin,

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.

Good luck.
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replied June 12th, 2013
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.
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replied July 6th, 2013
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.
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replied July 6th, 2013
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runhard,

You are only two weeks out from your injury.

It takes about six weeks for the bone to heal.

And, it takes a bit longer for the soft tissues to heal. So, you are going to have soreness around the fracture for an extended amount of time.


Wishing you the best.

Good luck.
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replied July 6th, 2013
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.
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replied July 7th, 2013
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runhard,

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”.


Wishing you the best.

Good luck.
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replied August 11th, 2013
Radial head fracture
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,
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replied March 22nd, 2014
radial head fracture
Hi I recently obtained a radial head fracture with soft tissue damage in my wrist as well.
It has been two weeks and I have taken it out of the sling and am moving it with 90% range of motion (still a fair amount of pain however) which is to be expected.
I am wondering what a reccommended time to return to the gym and lift weight (upper body exercises) would be. Should it be 6 weeks or do I have to wait longer.
My thinking is to listen to my body however some advice would be great Smile.
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replied May 8th, 2014
Hi there,
this thread has been extremely helpful! Especially the notes made by Gaelic. I am three weeks post injury. I was diagnosed with a radial neck impacted fracture. I am not using a sling and am moving my elbow. However, my range of motion is very restricted and I have some pain around my wrist and thumb which I suspect is just soft tissue damage. I am in training for a half marathon and am anxious to start training again. I am already 3 weeks with no training at all and am afraid that I have lost so much fitness already. I did try to run but I found that it was too painful. I am also nervous that the radial head becomes more displaced (It is 2mm dispaced at present) What are your views on resuming running training? Thanks for any help!
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replied May 29th, 2014
I broke my radius as well as my ulna both in two places. I was immobilized for 8 weeks, 4 of them in a full arm cast including my elbow. The fractures healed nicely (although I now need surgery because I had torn ligaments that did not heal). Just a word of warning to expect that you will probably need extensive physical therapy for your elbow as well. I lost all ROM in both the wrist and elbow and it took about 6 weeks to regain full ROM in my elbow with VERY extensive PT.
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replied June 18th, 2014
hi my name is derek and i am a right handed guitaris and suffered a radial head fracture, type I, and today i saw the orthapedic surgeon at the fracture clinic. today is 8 days since the injury. he cut off my cast, xrayed it, said it looks good, and sent me home. i was in a great mood thinking since i can move my wrist somewhat that i can try guitar. i couldnt have been more wrong. GOD i couldnt have been more wrong.after i finnished sweating and swearing like a sailor i realized that while gripping my forearm muscle..the bulgy part.. i had mych more motion in my wrist and vast reduction of throbbing ripping arm off pain.. should he have recomended physio? or at the least a tensor bandage? if so what should i be doing? im not looking to throw shot put but picking guitar strings is physically impossible with this pain, and guitar is my job... so im looking to atleast just loosen my rock hard forarm muscle enough to be able to play Sad also, cant rotate my right hand to the right without agony. to the left hurts but is bareable. please help Sad
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