A radial neck fracture is one of the more common elbow fractures in kids. Fracture is just the medical term for break. There can be some complications with this fracture or break, so it is important to get appropriate treatment. Read on to learn more about radial head fractures. Let’s start with anatomy!
The elbow
The elbow joint is where the humerus, ulna, and radius come together. The humerus is the upper arm bone and forms individual joints with the ulna and radius, which are the forearm bones. The radius and humerus form the humeroradial joint and the ulna and humerus form the humeroulnar joint. The radius and the ulna will also form a joint which is called the radioulnar joint. These 3 joints make up the elbow joint.
Movements of the elbow include flexion and extension. Flexion is when the forearm and upper arm come closer together (bending the elbow) and extension is when they move farther apart (straightening the elbow). The radioulnar joint allows for the movements of pronation and supination. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The radial head and neck
The radial head is at the top of the radius. It is a thick, disc-shaped area that joins with the end of the humerus to form the humeroradial joint. The side of the radial head touches the ulna forming the radioulnar joint. The radial head also helps to stabilize the elbow.
The radial neck is located just below the radial head and acts as support for the radial head. The radial head ossifies or hardens in children around 3-5 years old. The radial head does not fuse to the neck until around the ages of 16-18. This means that the radial neck is more cartilaginous and more susceptible to injury than the radial head.
What is a radial neck fracture?
A radial neck fracture is a break of the radius at the radial neck. Radial neck fractures comprise up to 10% of all elbow fractures in children. It tends to occur between the ages of 9-10 years old. It is commonly caused by a fall on an outstretched hand. This is called a FOOSH injury. The force from the fall is transmitted from the hand and wrist up to the top of the radius. The radius breaks at its weakest point which is, most likely, the radial neck. It can also be caused by an elbow dislocation. Radial neck fractures are more common in children, but radial head fractures are more common in adults.
What are symptoms of a radial neck fracture?
- Pain and tenderness at the elbow
- Refusal to move the elbow
- Especially in pronation and supination
- Swelling at the elbow
- Bruising at the elbow might occur
- Pain may be referred to the wrist
Are there usually other injuries that occur with a radial head fracture?
Other injuries can occur with a radial head fracture. These injuries include:
- Ulnar fractures
- Fracture of the humerus at the elbow
- Ligament damage
Will my child need surgery?
The answer is maybe. If the radial neck has translated less than 2-3mm and has less than a 30-degree angulation, then surgery is not required. The arm is immobilized in a splint or cast for about a week. This will be followed by gentle movement of the elbow to prevent stiffness. If the fracture has translated greater than 3mm or the angulation of the radial neck is greater than 30 degrees, a closed reduction can be attempted. This means that the physician will attempt to put the radial neck back in place. A cast or splint will then be put on the arm. If this is unsuccessful or there are other injuries, then surgery would be needed.
Are there any potential complications?
There are some complications associated with radial neck fractures. These include:
- Elbow stiffness and limited forearm rotation – This is the most common complication after this fracture. Early motion exercises are necessary to maintain the mobility of the elbow joint.
- Nonunion – This means that the fracture is not healing and there is little chance of it healing without surgical intervention.
- Malunion – This occurs when the bone heals in an abnormal position. The bone will look bent, and its position could affect the function of the joint.
- Avascular necrosis – This is caused by a lack of blood flow to an area of bone. This in turn causes that area of bone to die.
- Cubitus valgus – This is a misalignment of the elbow joint. It causes the forearm to be deviated away from the body when the elbow is straight.
- Overgrowth of the radial head – Increased growth of the radial head could also occur. However, this doesn’t tend to cause any additional issues or affect overall recovery.
- Compartment syndrome – This is a very serious condition that involves pressure buildup in the tissues. This can cause decreased blood flow and damage to the nerves and muscles.
- Posterior interosseous nerve injury – This nerve runs right beside the radial neck. If it is damaged, it could cause weakness in the wrist and hand.
Who should I see?
- Physician – If you suspect that your child has sustained a radial neck fracture (or some other type of fracture), it is best to go to the emergency room. Because of the potential complications, this fracture should be treated quickly. However, if your fracture has already been treated and you suspect additional injury or complication, then it would be best to see your orthopedist, pediatrician, or primary care physician. Additional imaging and inspection might be needed to rule out other conditions.
- Physical therapist – Physical therapy might be needed if your child is having difficulty regaining strength and/or motion around the elbow. Kids usually do not need therapy because they tend to perform their own therapy by playing. My son broke his radius and ulna at the wrist when he was 5. He was able to regain full function and motion with little help from me. However, if stiffness or strength is not improving, then physical therapy can be very helpful. Your PT can evaluate your child to determine the extent of their deficits and use manual therapy, as well as, stretching, and strengthening to help address all problems in and around the elbow.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to allow the bones to heal. If your child is not able to participate in your activity or sport, then you can supplement with non-irritating activities such as walking, or jogging while the elbow is healing.
- Ice – Ice can help decrease pain and symptoms at the elbow. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- The following are activities that your child can do after the cast is removed or you are cleared by your surgeon.
- Elbow stretches – The elbow might have limited motion in certain directions. Typically, extension or straightening the elbow is the hardest to fully regain. However, depending on the person and the injury, then flexion, pronation, or supination might also be tight. See the video below in how to stretch the muscles around the elbow.
-
- Wrist flexion and extension stretching – You will also need to stretch out the wrist flexors and extensors. These muscles attach at or near the elbow and could be tight. See the video below.
-
- Strengthening the muscles around the elbow and wrist – Strengthening the muscles around the wrist and elbow are also important in being able to return to your activity. Decrease your resistance or number of repetitions if the pain is moderate to severe during the exercise or returns after the exercise. Using dumbbells or resistance bands can increase strength and difficulty. See the videos below.
In review
- The elbow joint is where the humerus, ulna, and radius come together.
- The radius and humerus form the humeroradial joint and the ulna and humerus form the humeroulnar joint.
- The radius and the ulna will also form a joint which is called the radioulnar joint.
- These 3 joints make up the elbow joint.
- Movements of the elbow include flexion, extension, pronation, and supination.
- The radial head is at the top of the radius.
- It touches the humerus and ulna to form the humeroradial joint and the radioulnar joint.
- The radial neck is below the radial head and functions to support the radial head.
- A radial neck fracture is a break of the radius at the radial neck.
- Swelling, pain, and refusal to move the elbow are symptoms of a radial neck fracture.
- Seek immediate medical help if you suspect a fracture.
- Physical therapy will play a role if there is difficulty in regaining strength and mobility in the elbow.
- There are things your child can do once the cast is off or they are cleared by the surgeon.
- Ice
- Soft tissue mobilization
- Elbow stretches
- Wrist stretches
- Strengthening of the muscles around the elbow and wrist
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.orthobullets.com/pediatrics/4011/radial-head-and-neck-fractures–pediatric
https://posna.org/physician-education/study-guide/proximal-radius-(radial-neck)-fractures