OVERVIEW
The most common cause of a radial head fracture is the reflexive movement usually made by someone upon falling onto the ground: they fall onto an outstreched hand in an attempt to support themselves and reduce the momentum. This movement, however, is the most common cause of fractures in the elbow, as the force of the fall is transferred to the forearm, through the wrist. More often – to be more precise, at a rate of 60% - the point of injury is the head of the radius, which absorbs about 60% of the loads, is articulated with both the humerus and the ulna, and its role is to allow the rotations of the forearm. Another mechanism of injury is to fall directly on the elbow or a collision.

HIGH RISK GROUPS
Global epidemiological data indicate that this injury regards all age groups, with rates showing an upward trend. In fact, they are related to age, gender and level of activity, but also to factors such as the climate and population density. High-risk groups include boys and young adults, but also elderly women. At young ages, the fracture at the head of the radius occurs from a fall during a game or during sports activities, or it is a consequence of a traffic accident. Contrariwise, at older ages, it is the result of falling from a very low height.

WHICH ARE THE SYMPTOMS?
Immediately after the injury, the patient feels pain in the elbow area, mainly on the outside, even when the arm is motionless. Pronation and supination movements are particularly painful, pain can also be present in the wrist, while the range of flexion and extension of the hand is significantly reduced.

DIAGNOSIS
Orthopaedists classify the radial head fractures in three types: a) non-displaced, when the bone is broken, but remains in its normal position; b) partially displaced, when a part of the bone is displaced from its normal position; and c) comminuted, when the bone is broken into more than two fragments.
Diagnosis is performed through a simple x-ray. 3D Computed Tomography and / or Magnetic Resonance Imaging is required, in cases of displaced fractures so that the orthopedist can see if there are other concomitant lesions in the elbow, such as other fractures or ligament disruptions.

WHICH IS THE BEST TREATMENT?
Excluding comminuted fractures which always require a surgical replacement so that the bone acquires its right anatomical shape, the other fractures are treated conservatively. The arm is placed into a splint or cast for 4-6 weeks, so that porosis can be facilitated through immobility. The physiotherapist plays an important role, too.  Depending on the type of fracture, he will design an exercise program so that the shoulder, the wrist and the hand can maintain the range of movement, while stiffness, muscle atrophy and swelling in the hand can be reduced.
In the most straightforward cases of patients who undergo surgery, an open resetting and consequently, an osteosynthesis with screws are performed. In more severe cases, an osteosynthesis with small plates and screws may be required, but, almost always, a degree of stiffness in the elbow remains. If the radial head is shattered – it is usually about older patients - then it is either removed or replaced by a metal head. Postoperatively, patients follow an intensive physiotherapy program and most of them return to their daily activities within 2-3 months.

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