72.14 Fractures of the head of the radius (adults)

In this common injury a force travelling up the patient’s arm drives the head of his radius against his capitulum. What happens depends on his age: (1) In a child the neck of the radius bends so that its head is displaced anteriorly and laterally, but the head itself almost never fractures. (2) In an adult the head may crack, a piece may chip off, it may break into many pieces, or the whole head may displace elsewhere in the joint. Treatment must be prompt and adequate.

Figure 72.20: FRACTURES OF THE HEAD AND NECK OF THE RADIUS are common injuries and can usually be treated conservatively. The patient’s elbow and his X–ray may look so normal that the frac-ture is easily missed. Kindly contributed by Peter Bewes.

Typically, the contour of the patient’s arm is normal, and not greatly swollen. He is able to flex and extend his elbow a little, but he cannot rotate his wrist. The head of his radius is tender. His elbow and his X–ray may look so normal that the fracture is easily missed. If you think that he might have fractured the head of his radius, but his X–ray looks normal, treat him conservatively and X–ray him again in a week; the fracture will then be more obvious.

In the instructions below we advise you treat a patient conservatively if you possibly can. Although the operation itself is not difficult, you can easily cut the deep branch of his radial nerve (posterior interosseous nerve); so refer him if possible.

ROLF (37 years) fell on the ice, and broke the head of his radius, sustaining Fracture B, in Fig. 72-20. Instead of treating him with active movements, an ’expert’ orthopaedic surgeon immobilized his arm, quite unnecessarily, in a cast for several weeks. When this was removed his arm was stiff for several more weeks. LESSONS there are many fractures for which a cast is NOT indicated!