RADIAL HEAD FRACTURES, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Abstract

Introduction: In recent years the understanding and comprehension of the elbow has improved, clarifying some aspects of the complex diarthrodial joint. The relevance of the radial head in the biomechanics of the elbow is recognized which helps to improve the management and treatment of fractures at this site. Elbow trauma is the most common origin of proximal radius fractures, this trauma can be direct or indirect and can cause an isolated fracture, a fracture associated with other fractures and ligament injuries.

Objective: to detail the current information related to radial head fractures, epidemiology, anatomy, presentation, clinical evaluation, imaging evaluation, classification, treatment and complications.

Methodology: a total of 42 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 31 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: radial head fractures, radial head prosthesis, radial head arthroplasty.

Results: Radial head fractures have an incidence of 2.5 per 10,000 per year, which represents 1.7 to 5.4% of all fractures. Most radial head injuries are the result of a fall on the hand in extension. Usually the affected individuals show limitation of mobility of the forearm and elbow in addition to pain or discomfort when making passive rotational movement of the forearm; they also usually present pain on palpation over the radial head and joint effusion in the elbow. Sometimes there is a fracture-dislocation of the radial head related to a rupture of the interosseous membrane with lesion of the distal radioulnar joint called Essex-Lopresti lesion.

Conclusions: The radial head together with the interosseous membrane of the forearm provide longitudinal stability; when the interosseous membrane is damaged, a proximal migration of the radial head may occur after removal of the radial head. When presenting clinical suspicion of elbow fracture, standard anteroposterior and lateral projections of the elbow should be requested, as well as oblique projections such as the Greenspan projection. The Manson, Mason-Johnston or Mason classification modified by Hotchkiss is usually used for classification. Among the indications for conservative treatment are solitary, undisplaced or minimally displaced fractures that do not present mechanical blockages in the range of motion or less than 3 mm of displacement. Studies report the effectiveness of open reduction and internal fixation of simple Mason type II fractures; Manson type III fractures are controversial.

Complications usually arise from contracture subsequent to prolonged immobilization or secondary to persistent pain, edema and swelling; which may be due to undiagnosed osteochondral injury of the capitellum.