Radial Head Fracture

Approximately one-third of elbow fractures (or broken elbows) involve the head of the radius bone. The elbow is a joint where the upper arm bone (humerus) connects to the two bones of the forearm (radius and ulna). The radial head is the upper part of the radius that connects to the humerus, close to where the elbow bends. The elbow not only allows our arm to bend, but it allows us to rotate our forearm, like when opening a doorknob. Radial head fractures happen more commonly in women and often occur at the same time as an elbow dislocation. 

“The symptoms of a radial head fracture are often felt immediately.”


The symptoms of a radial head fracture are often felt immediately at the time of the injury:

  • Severe pain in the elbow
  • Bruising and swelling 
  • Difficulty bending or extending the arm 
  • Difficulty rotating the forearm


Any impact that twists, sprains, or delivers substantial force to the elbow can cause a radial head fracture. Radial head fractures are usually caused by sudden trauma, such as extending an arm to break a fall.


Your doctor will first perform a history and physical exam to look for elbow range of motion, elbow instability, and signs of other injuries. Radial head fractures are usually diagnosed with an x-ray. Additionally, doctors may order a CT scan to study complicated fractures in greater detail to help plan surgical treatment.

Radial head fractures are sorted into different types, which helps doctors determine how they will be treated. 

  • Type 1 fractures are small cracks in the bone, but the elbow bones remain in their proper places. 
  • Type 2 fractures have larger cracks in the bone, and the bones may be slightly out of alignment with each other. 
  • Type 3 fractures are the most serious, with the radial head being broken in multiple places and damage to the elbow ligaments and tendons. 
  • Type 4 radial head fractures mean there has also been an elbow dislocation. Their treatment depends on the severity of the fracture.

Nonsurgical treatment options

Nonsurgical treatment is used for type 1 and small type 2 radial head fractures—when there is a small crack or break in the bone, but otherwise the elbow is still in proper alignment. In these cases, conservative treatment with a sling to immobilize the arm is used. While immobilization helps the bones heal, it may also lead to stiffness and reduced dexterity. Therefore, it is important to also consult with a physical therapist after your injury, even if it is only mild.

Large type 2 and all type 3 fractures require surgery. These fracture types can actually prevent the elbow from bending or cause the elbow to be unstable. Without timely care, there is a chance patients may suffer nerve damage, long-term stiffness, permanent deformity, and chronic arthritis. 

After any radial head fracture, some range of motion will be lost, but a course of physical therapy can help people reclaim maximum flexibility and function. 

How surgery is performed

Dr. Romeo will recommend a surgical treatment plan based on your exam and imaging results. Surgery is the best option to prevent long-term loss of function in the elbow with more serious radial head fractures. He will determine if an open reduction and internal fixation (ORIF) procedure, a fragment excision, or a radial head replacement would be your best option for treatment.

During an open reduction and internal fixation (or ORIF) procedure, the surgeon cuts through the skin and muscle to access the broken bone, mend it, and return it to proper alignment. This is performed with general anesthesia (meaning you will be totally unconscious) and may take several hours. The term “internal fixation” refers to the way your surgeon reconnects the bone, sometimes using plates and screws.

Depending on how seriously the radial head was fractured, damaged bone fragments from the arm may need to be removed (called fragment excision). In some cases, the radial head itself may need to be removed (radial head excision). These bone fragments can impede proper elbow movement and cause long-term problems. Patients who don’t have a very active lifestyle may not be significantly inconvenienced by the absence of the bone. 

On the other hand, younger or more physically active patients may prefer having the fractured radial head surgically replaced with a prosthesis (called radial head replacement). As with many elbow injuries, there may be damage to other joints, bones, ligaments, tendons, or muscles, so Dr. Romeo will also repair any soft tissue injuries during the procedure.

“After any radial head fracture, some range of motion will be lost, but a course of physical therapy can help people reclaim maximum flexibility and function.”

Recovery time

After surgery, you will be given a sling or cast to help protect your elbow as it heals. When the sling will be removed depends on the severity of your injury. After surgery, you will need to follow a program of physical therapy, supplemented by home exercises, to rebuild strength and flexibility in the muscles and ligaments to ensure maximum range of motion. Dr. Romeo will provide specific instructions to manage any post-op pain.


Pain typically starts to ease within two to three weeks after surgery. While recovery times vary depending on the severity of the injury, strenuous tasks should generally be avoided for three to six months to allow the fracture to fully heal.

Long-term issues related to radial head fractures include stiffness, pain, and arthritis of the elbow. The good news, however, is that for most people, the stiffness experienced does not greatly affect the use of their arms.


What happens if a radial head fracture is left untreated?

Without proper treatment, radial head fractures can lead to long-term complications including loss of elbow range of motion and frequent pain.

For more information about causes and treatment of radial head fractures, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.

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