The forearm has two long bones, the ulna and the radius. The upper end of the ulna is called the olecranon. The upper part of the radius forms a little spool that allows rotation of the forearm at the elbow. Fractures of the radial head occur during falls onto an outstretched arm. They range from non-displaced cracks in the bone, to widely displaced fractures with an unstable joint.
Most of these are treated with non-operative consisting of a sling and or splint for the first 7-10 days and then gradual resumption of activities after the splint is removed. Physical therapy is not typically necessary as the vast majority of patients regain motion and function spontaneously over a 6-8 week period.
In fractures that are displaced or unstable, either open reduction and internal fixation or radial head arthroplasty will be indicated. If the fragments are large and the bone quality is good, primary repair of the fracture with small plates and screws may be successful. This surgery may be done as an outpatient. Patients are immobilized in a splint for a brief period of time post-operatively.
Radial head arthroplasty involves replacing the fractured radial head with an artificial radial head. This procedure is done as an outpatient procedure, similar to open reduction and internal fixation. After surgery, the arm is placed in a soft case for about 2 weeks and then therapy is initiated to regain function. Most patients recover fully with only minor limitation of function, but full recovery can take 3-6 months.
The primary long term problem that develops after surgery is stiffness of the elbow joint. Most patients are able to bend fairly well but getting the elbow completely straight is often troublesome. Patients should expect to lose 5-10 degrees of extension (ability to completely straighten the arm) the healing process is complete. Unfortunately, surgical release of the scar tissue around the elbow often makes the problem worse. This approach is only indicated in the most severe contractures. A Dynasplint (a dynamic splint worn in part of the time) is a helpful adjunct to help prevent stiffness, in conjunction with physical therapy. This can help patients regain motion more quickly.
For more information about surgery, what to expect after surgery and some useful tips and FAQ’s, look at the post-op elbow instruction sheet (link below). It contains a lot of information about surgery. If you’re scheduled to have surgery on your elbow, you should read this.