Radial-neck-fracture-diagnosis-treatment-and-management – Radial head fractures account for approximately one-third of elbow fractures and 1% to 4% of fractures in adults. Radial head fractures are common injuries, occurring in approximately 20% of all acute elbow injuries. Approximately 33% of elbow fractures and dislocations involve injuries to the radial head, radial neck, or both. Many elbow dislocations also involve radial head fractures.
Radial head fractures are more common in women than men and occur more often in people between the ages of 30 and 40.
Radial head fractures and dislocations are traumatic injuries that require appropriate treatment to prevent disability from stiffness, deformity, post-traumatic arthritis, nerve damage, or other serious complications. Radial head fractures and dislocations may be isolated to only the radial head (and neck) and lateral elbow (and proximal forearm) or may be part of a combined pattern of complex fracture injuries involving other structures of the elbow, distal humerus, or forearm, and wrist. .
Buckle Fractures Of The Distal Radius In Children
Treatment of a radial head fracture depends on the degree of displacement and involvement of the articular surface (as well as associated injuries). In general, type I injuries (see Mason classification below) can be treated conservatively, while type II injuries require open reduction and internal fixation (ORIF)
Radial head replacement is also an option to help stabilize the elbow joint and prevent proximal migration of the radius.
In general, patients can expect a good outcome, although secondary osteoarthritic changes are certainly encountered in patients with intra-articular fractures.
Ligaments on the inside and outside of the elbow hold the joint together, and muscles surround the joint in front and back. The elbow joint is traversed by three main nerves.
Olecranon Fracture Causes, Symptoms, Diagnosis, Treatment & Prognosis
The annular and radial collateral ligaments stabilize the radial head. These ligaments are stretched or torn during radial dislocation of the head
. The radial head articulates with the humeral capital and the radial notch of the proximal ulna. The radius and ulna are closely invested by the interosseous membrane, which explains the increased risk of displacement or injury of the radius when the ulna fractures.
. The ulna provides a stable platform for radius and forearm rotation. The ulna and interosseous membrane can also provide stable platforms for dislocation of the proximal radius, resulting in a Montagu fracture.
The posterior interosseous nerve travels around the neck of the radius and dips under the supinator as it travels into the forearm. The median and ulnar nerves enter the antecubital fossa just distal to the elbow. Proximity of these nerves can lead to injury when a radial head fracture occurs. Neural injuries are generally traction injuries and result from stretching around the displaced bone or from energy dispersed during the initial injury.
Radial Head Elbow Fracture: Symptoms And Treatment
An arc of 180 degrees in pronation and supination is allowed by the articulation of the proximal end of the radius with the distal humerus (the capitulum), and with the ulna in the lesser sigmoid cup (the trochoid joint). Cartilage covers the radial head except for the anterolateral third which lacks subchondral bone and breaks easily. It has a central cavity of 40 degrees and is oval in size. The head and neck are not collinear with the diaphysis and complete an offset angle of 15 degrees. They are closely related to the lateral ligament complex, mainly the annular ligament and the radial collateral ligament
The physiological range of motion of the elbow is 0 to 150 degrees of flexion and extension and 85 degrees of pronation and 75 degrees of supination.
The radial head stabilizes in the valgus when the internal ligament complex is injured and does not participate when it is harmless (secondary stabilizer). In addition, it is involved in longitudinal stability
The Mason classification is used to classify radial head fractures and is useful in evaluating further treatment options.
Effect Analysis Of Different Methods On Radial Neck Fracture In Children
In general, type I injuries can be treated conservatively, while type II injuries require open reduction and internal fixation (ORIF). Type III lesions often require early complete excision of the radial head
Radial head fractures usually occur as a result of indirect trauma, and most are the result of a fall on an abducted arm with minimal or moderate elbow flexion (0-80 degrees).
. This results in valgus pronation stress, with the radial head forced against the capitulum of the humerus.
. In practice, history often gets out of hand. A direct blow to the elbow can also cause a radial head fracture, but is less common.
Diagnosis, Treatment And Complications Of Radial Head And Neck Fractures In The Pediatric Patient
A patient with a fracture-dislocation of the radial head usually presents with a history of falling on an outstretched arm. Blunt or penetrating trauma rarely causes injury to the radial head. The joint, especially the distal radioulnar joint, may be injured simultaneously, and the presence of joint pain, grinding, or swelling should be determined.
The presence of bleeding, even with small puncture wounds, should alert the examiner to the possibility of an open wound. Neurovascular symptoms of numbness, tingling, or loss of sensation should be identified to rule out nerve or blood vessel damage. The presence of severe pain should alert the examiner to the possibility of compartment syndrome.
Patients with radial head fractures and dislocations present with localized swelling, tenderness, and decreased range of motion. The doctor should carefully examine all wounds to make sure there are no open fractures. Evaluation of wounds above the subcutaneous border of the ulna is particularly important in fracture-dislocations to ensure that open fractures are not missed. The examiner should palpate the elbow, especially the radial head, feeling for deformity, and should also examine the joint, especially feeling for stability at the distal radioulnar joint.
Because all three major nerves of the forearm are at risk for elbow fractures and dislocations, the examiner should carefully assess neurovascular function for all nerves of the forearm and hand. The function of the radial nerve is especially important to evaluate with displaced fractures through the neck of the radius. The motor (posterior interosseous) branch provides extension of the fingers and wrist.
Percutaneous Leverage Technique For Reduction Of Radial Neck Fractures In Children: Technical Tips
The examiner should also assess the firmness of all compartments, check for pain by passive stretching, and measure compartment pressures if suspected to avoid compartment syndromes. It is necessary to assess elbow stability even with apparently intact radial neck fractures. The elbow is valgus stress tested at 30° of flexion to determine the competency of the medial collateral ligament.
Most radial head injuries can be adequately evaluated with a standard plain radiograph of the elbow. Normal findings on radiographic examination show that the radial head is aligned with the capital in all views. Radial head dislocation can easily be missed if all radiographs are not carefully examined for this relationship. For a normal elbow, a line drawn through the radial head and shaft should always line up with the capitellum, and in a supine lateral view, lines drawn tangential to the anterior and posterior head should enclose the capitellum.
With radial dislocation of the head, these radiographic findings are affected. The images below are examples of an injury that appears to be a simple ulna fracture when evaluating only the anteroposterior (AP) view, but clearly has a radially displaced head on the lateral view. As with any fracture assessment, two views perpendicular to each other are always required.
Footnote: There is a slightly displaced intra-articular fracture of the radial head with ~2 mm of articular displacement. Joint effusion is noted.
Femoral Head Fractures
Doctors classify fractures by the degree of displacement (how far the bones are from their normal position) (see Figure 4). Treatment is determined by the type of fracture, as classified below.
Even the simplest fractures can result in some loss of motion in the elbow. Regardless of the type of fracture or treatment used, exercises to restore motion and strength will be necessary before resuming full activities.
Patients whose medical condition is too unstable to allow safe surgery when surgery would otherwise be indicated can also be treated with suture followed by early motion, but the prognosis is protected to achieve optimal function.
Joint aspiration to relieve pressure has been used as an initial treatment measure, but its effectiveness is unclear.
Distal Radial Buckle And Radial Neck Fractures
Surgical treatment is indicated for all unstable radial fractures and dislocations of the head (and neck). As described above, the rule of three can be used to determine the need for surgery: surgery is required if the fracture involves more than 33% of the articular surface, is inclined more than 30°, or is displaced more than 3 mm. A mechanical motion block always requires open treatment to remove the blocking bone or osteochondral fragment or fragments.
Open fractures are also surgical emergencies. They require surgical irrigation and debridement in the operating room with appropriate antibiotics even if the wound is small. At the same time, immediate stabilization of the bone lesion is achieved.
A Kocher surgical approach between the anconeus and extensor carpi ulnaris provides good access to the posterior fragments and safety to the posterior interosseous nerve. Another option is the hand extensor ring to avoid iatrogenic injuries.
The osteosynthesis must be placed within a safe range to avoid interference with the proximal radioulnar joint which is 110 degrees external with the elbow in neutral pronation-supination.
Neck Of Femur Fracture
In complex fractures, osteosynthesis or prosthesis? It is convenient not to get more than three
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