What is the injury?

The radial head is the top part of the radius bone at the elbow. It is important for elbow stability and for forearm rotation. A radial head fracture usually occurs after a fall onto an outstretched hand.

 

These fractures range from small cracks to displaced fractures that block motion or occur as part of a fracture-dislocation injury. The treatment plan depends on fracture pattern, displacement, elbow stability, and whether there are associated injuries.

 

What are the symptoms?

Typical symptoms include pain on the outer side of the elbow, swelling within the elbow joint, difficulty bending or straightening the elbow, and difficulty rotating the forearm (turning the palm up and down).

 

How is it diagnosed?

X-rays are the main diagnostic test. In some cases the fracture is subtle and may be inferred from swelling within the joint. CT scanning may be used when the fracture pattern needs to be defined more clearly for surgical planning or when there is concern about associated injuries.

 

Non-surgical treatment

Many radial head fractures can be treated without surgery when the fracture is stable, well-aligned, and does not block motion. A sling is used for comfort and early movement is encouraged to reduce stiffness.

 

Pain usually improves over the first couple of weeks, but the bone typically takes around six weeks to heal. Early supervised motion is important because the elbow is prone to stiffness.

 

Surgical treatment

Surgery may be recommended if the fracture is displaced, if it blocks motion, or if it is part of an unstable injury pattern. Options include fixation with screws or plates, removal of small fragments, or radial head replacement in selected complex fractures.

 

In complex injuries, stability of the elbow is assessed and associated ligament or bony injuries may need treatment.

 

Recovery and rehabilitation

Rehabilitation is staged. Early motion is prioritised, and strengthening is introduced once healing and stability allow. Return to heavier activity depends on fracture severity and associated injuries.

 

Expected outcomes

Most patients regain good function, particularly when early motion is achieved. Stiffness and some residual discomfort can persist, especially after more severe injuries.

 

Risks and complications

Risks include stiffness, persistent pain, non-union (rare), malunion, instability, heterotopic bone formation, and post-traumatic arthritis. In complex patterns, there is also a risk of ongoing instability or forearm rotational problems.

 

When should I seek urgent review?

Seek urgent medical review if you develop increasing redness, heat, rapidly worsening swelling, fever, increasing pain that does not settle with rest, or new weakness or numbness in the hand. If you have had a recent injury and the elbow looks deformed, feels unstable, or you cannot move it, this also requires urgent assessment.

 

Surgery, Risks and Recovery

Surgery is considered when symptoms persist despite appropriate non-operative treatment, when imaging or nerve studies confirm structural pathology, or when weakness, locking, or mechanical symptoms are present.

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Operations are usually performed as day procedures under regional or general anaesthetic. Techniques depend on the underlying condition and may involve tendon debridement or repair, arthroscopic bone spur removal, loose body excision, fracture fixation, ligament reconstruction, nerve decompression, or joint replacement.

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General risks include infection, bleeding, stiffness, scar sensitivity, nerve irritation, persistent symptoms, recurrence, and the need for further surgery. Condition-specific risks are discussed prior to surgery.

Recovery varies according to the procedure performed. Gentle motion is usually encouraged early. Wounds typically heal within two weeks. Light activities resume over two to four weeks for minor procedures, while larger reconstructions or replacements may require several months of rehabilitation.

Patients often notice improvement within six to twelve weeks, although full recovery may continue for up to a year depending on the pathology treated.

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What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after elbow surgery please see our Rehabilitation Protocols here.