No fluff. No fads. Deep-dive investigative reports from the surgeon who actually sees the inside of the joints.
The radial head — the top of the forearm bone where it meets the elbow — is the most commonly fractured bone of the elbow in adults. It's also one of the most commonly missed. Subtle, non-displaced fractures can hide on a standard AP/lateral x-ray. The tell is indirect: a posterior fat-pad sign on the lateral view, meaning joint fluid has pushed the normally-hidden fat pad into visibility. That finding in an adult, with the right history, is a fracture until you prove otherwise.
Radial head fractures are graded by the Mason system — which largely dictates treatment:
Non-displaced or minimally displaced (<2mm). No block to motion. Sling + early motion within 5–7 days.
Displaced >2mm or angulated. If a mechanical block exists, surgical fixation (ORIF with mini-screws or plate).
Comminuted (multiple fragments). Often needs ORIF or radial head replacement if reconstruction isn't feasible.
Any of the above with elbow dislocation. Complex injury pattern — high risk of associated ligament injury.
After a fall on outstretched hand (FOOSH), here's what I test:
Firm tenderness over the lateral elbow joint line (3 cm distal to the lateral epicondyle) while pronating and supinating.
Flexion, extension, pronation, supination — compared to the uninjured side. A mechanical block is a surgical finding.
Distal radioulnar joint tenderness raises suspicion for an Essex-Lopresti injury — a spectrum that requires very different treatment.
For borderline cases, a 5 mL lidocaine injection into the joint eliminates pain. If range of motion returns fully — it's a nondisplaced fracture. If a block persists — there's a fragment.
"The goal isn't perfect imaging — the goal is a painless elbow that moves. Early motion, even with a fracture, saves more elbows than strict immobilization."
— Dr. Sameh Elguizaoui
Mason I: Sling 3–5 days for comfort, then active range of motion. Most full recoveries by 6 weeks.
Mason II without block: Often manageable non-operatively with early motion. Displaced but not blocking? Many surgeons will observe and operate only if symptoms persist.
Mason II with block / Mason III: ORIF with small-fragment screws or a small plate. When fragments are too small or numerous to reconstruct, a modern radial head replacement (metallic prosthesis) preserves elbow kinematics better than excision.
Mason IV: Fix or replace the radial head and address associated injuries — LUCL repair, coronoid fixation.
The elbow is the least forgiving joint in the body when it comes to immobilization. Three weeks in a cast can leave a permanent 30° extension deficit. The orthopedic dogma on radial head fractures has swung in favor of early motion for this reason — even a surgically fixed elbow starts gentle ROM within the first week.
of adult elbow fractures are radial head
excellent outcomes for Mason I with early motion
target for initiating ROM, even post-op
Sling for comfort. Begin gentle active flexion/extension and pronation/supination.
Progressive range of motion. Aim for 30–130° by end of week 4.
Light strengthening. Full motion expected. Heavy lifting restricted.
Return to most activities. Contact sports may require longer for displaced fractures.
A radial head fracture is often a "simple" injury that ends in a stiff elbow because patients and providers default to immobilization. Get the right imaging, get the right grade, and get moving early. The elbow rewards motion and punishes rest.
Expert elbow evaluation — x-ray, ultrasound, and MRI as needed — across our NYC offices.
Book a Consultation →Avoid loaded elbow flexion and any pushing or pulling for 3–4 weeks. Lower body and core work is fine. Stationary cycling (straight arms) is fine.
Not if treated correctly. Small permanent end-range deficits (5–10°) happen occasionally but rarely impact function. Large deficits usually trace to prolonged immobilization.
Modern implants are titanium or cobalt-chrome with a polished articular surface. They're designed for the small load the radial head actually carries.
It's a radial head fracture with disruption of the interosseous membrane and distal radioulnar joint — basically the forearm longitudinally destabilizes. Missing it leads to chronic wrist pain. Wrist exam matters.
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