Other Fractures

Radial head fractures

Radial head injuries usually follow a fall onto an outstretched wrist or direct trauma. Radial head fractures usually occur in adults and account for 30% of all adult elbow fractures [3].

The x-ray shows a displaced radial head fracture
Examination may reveal local bruising and swelling. In some cases pain may only be evident with palpation of the radial head during passive forearm pronation. Elbow extension is usually restricted.
Assessment of the wrist should be performed due to the possibility of an Essex-Lopresti fracture-dislocation, consisting of a comminuted radial head fracture with subluxation of the distal end of the ulna.
Radiography may reveal the fracture or merely the presence of a joint effusion.

Learning bite

Pain due to a radial head fracture may only be evident with palpation during passive forearm pronation.

Olecranon fractures

With olecranon fractures the mechanism of injury is usually a fall onto the point of the elbow or onto a semi-flexed outstretched forearm.

The x-ray shows a displaced olecranon fracture
Examination will reveal swelling and tenderness over the posterior aspect of the elbow. Radiography will confirm the diagnosis and also reveal any displacement due to the pull of the triceps tendon.
Identification of paediatric olecranon fractures may be complicated by the appearance of the olecranon ossification centre, which may be bifid.

Learning bite

Care should be taken when attempting to identify or exclude a fracture in a child with an olecranon ossification centre.

Monteggia fracture-dislocation

A Monteggia fracture-dislocation injury comprises of a dislocation of the radial head with an ulna fracture. It may result from a direct blow to the ulna or forced pronation.

The x-ray shows a Monteggia fracture-dislocation with partially visible ulna shaft fracture.

The radiographic appearance of a dislocated radial head (suspect if a line bisecting the radius longitudinally does not pass through the centre of the capitellum) should prompt further imaging of the forearm to exclude an ulna fracture.

Learning bite

Radial head dislocation should raise suspicion of an associated ulna fracture.

Galeazzi fracture-dislocation

A Galeazzi fracture-dislocation injury consists of a radius fracture in combination with dislocation of the inferior radio-ulnar joint at the wrist. The wrist joint should therefore be imaged and closely inspected when a radial fracture is identified.

The x-ray shows a Galeazzi fracture-dislocation
The possibility of combined injuries such as those recognized by Galeazzi and Monteggia illustrates the need to image the elbow, wrist and entire radius and ulna when one bony injury is identified.

Learning bite

The presence of a radius fracture should raise suspicion of associated distal radio-ulna joint dislocation.