A 25-year-old female presents to the emergency department with elbow pain after falling on an icy surface. On examination, she has tenderness just distal to the elbow on the lateral forearm and refuses to pronate or supinate. Imaging reveals a minimally displaced fracture of the radial head with fluid in the joint. Radial head fractures commonly involve the lateral surface of the radius and may appear as a step off or abnormal angulation on lateral X-ray views. Treatment involves sling immobilization, ensuring full range of motion to prevent stiffness, followed by physical therapy and orthopedic follow up.

2.  A 25yo female presents to ED with CC elbow pain after
FOOSH from slipping on ice. Pt is tender just distal to
the elbow, on the lateral aspect of the forearm and
refuses to pronate or supinate

4.  Minimally displaced fracture of radial head with
hemarthrosis
 Commonly located along the lateral joint surface of radius
 Usually vertically oriented
 May see step off or abrupt angulation of radial head surface
 Best imaging clues (look at true lateral plain film)
 Displacement (“sail sign”) of anterior fat pad
 Posterior fat pad is always abnormal

5.  Sling
 Ensure full passive ROM
 Decreased ROM can indicate intra articular fx fragment that
may require surgical treatment
 Physical therapy and early mobilization to prevent frozen
shoulder
 Ortho follow up
 For severely comminuted fractures, the radial head may be
excised
 Prognosis
 Non-displaced fracture or successful early reduction results in
minimal to no loss of elbow extension
 Displaced fracture or delayed management may lead to
permanently restricted range of motion, traumatic arthritis, or
myositis ossificans

6.  History classically of a FOOSH—the force is transmitted
along the longitudinal axis of radius, compressing the
radial head agains the capitellum
 Most common adult elbow injury
 50% of adult elbow injuries
 15% of elbow injuries in children, with supracondylar
fractures being far more common
 Can be associated with injuries to the radial-ulnar
interosseous membrane, as well as other fractures (Colles’,
scaphoid, radial capitellum, and other distal radius, ulna,
and carpal fractures
 Occult fractures not seen on AP and lateral views may be
apparent on oblique views
 Disruption of the radiocapitellar line may be only sign of
radial head fracture in children

9.  Marx J MD; Hockberger R MD; Walls R MD. Rosen’s
emergency medicine. 7th ed.
 Simon R; Sherman S; Koenigsknecht S. Emergency
orthopedics: the extremities. 5th ed. McGraw Hill
Publishing.
 Wheeless C R III MD. Wheeless textbook of
orthopedics. www.wheelessonline.com.