The proximal radius fracture or spoke head fracture occurs at the level of the elbow and is caused by indirect or direct force on the joint or forearm.
The elbow joint is formed from three bones: the two forearm bones, ulna and spoke (ulna and radius) and the humerus.
These bones act together when the elbow, forearm and wrist are moved.
The spoke is the smaller bone of the forearm and articulates with the ulna (spoke-elbow joint or radioulnar joint) to allow the inward and outward rotation of the forearm (supination and pronation).
The upper arm-spoke joint allows the rotation of the forearm, the flexion and extension of the elbow.
The elbow is stabilized by ligaments; near the joint run the humeral artery (brachial artery) and the nerves of the arm plexus (brachial plexus): median nerve, spoke nerve and elbow nerve.
The proximal fractures of the spoke near the middle of the body may have undisplaced (not dislocated) or displaced (dislocated) fracture ends.
Mason’s classification system is used to choose the treatment method and prognosis.
- Type I: the proximal radius fracture is not dislocated and the joint is minimally affected; under certain circumstances, it is difficult to detect on the basis of image diagnostics.
- Type II: the fracture ends are at least 2 mm apart; They can be rotated or bent (angled).
- Type III: the spoke head breaks into many fragments (debris fracture).
- Type IV: Debris fracture plus dislocation of the elbow.
Causes of radius fracture
As a rule, a proximal radius fracture is caused by a fall on the open hand or by a direct blow to the outer elbow.
It can also occur together with fractures of other bones of the elbow joint (humerus and ulna) or injuries to the nearby soft tissues (tendons, muscles, ligaments, nerves, blood vessels).
It often happens that patients with spoke head fracture also have damage to the collateral ligament of the ulna or spoke.
Osteoporosis is not one of the most important triggers in these fractures, older people are not particularly frequently affected.
Signs and symptoms of radius fracture
Typical symptoms of a radial head fracture include:
- pain, especially when moving the elbow,
- restriction of movement,
Diagnosis of radius fracture
If elbow fracture is suspected, the doctor should be consulted as soon as possible.
As a rule, the orthopedist prescribes an X-ray examination to confirm the diagnosis and assess the extent of the injury.
CT scan of the elbow is performed in rare cases to determine the type of fracture.
Treatment of radius fracture
Spoke head fractures are classified according to the degree of displacement of the bone fragments.
immobilization (angle up to 30 degrees)
In young children, the fracture can be treated by simple immobilization, if the angle of the spoke head is less than 20-30 degrees.
A splint or plaster usually provides sufficient support and protection against further injury.
Suction of the joint effusion can alleviate the symptoms.
Closed device with manipulation (30-60 degrees)
For simple fractures with an angle of up to 60 degrees, a satisfactory result can be achieved by manipulation and closed setup.
If the angle is greater than 60 degrees, this becomes increasingly unlikely.
Although acceptable results can be achieved at angles of 45 degrees, angles greater than 30 degrees should be manipulated.
manipulation technique Many doctors use a manipulation technique in which the elbow is stretched, as advocated by Patterson.
It is important that the body is sufficiently relaxed, which can only be achieved by general anesthesia or certain types of local anesthesia.
The annular ligament should be intact to stabilize the proximal spoke head fragment.
In Patterson’s technique, the assistant captures the elbow joint with one hand at the level of the upper arm.
The other hand is positioned on the inside at the lower end of the humerus to represent a middle pivot point for the varus stress (outwards) that arises at the elbow.
The surgeon applies a distally acting tensile force; the forearm is turned outwards to relax upper arm biceps and outward turns.
A varus force is used via the elbow to overcome the ulnar deviation (displacement inwards) of the end of the fracture far from the body and to bring it onto an axis with the end of the fracture close to the body.
This varus force also helps to open the outside of the joint, making it easier to manipulate the spoke head fragment.
Surgical treatment is provided for unstable radial head fractures and dislocations.
The need for surgery arises from the rule of 3: an intervention is necessary if the fracture occupies more than 33% of the joint surface, is larger than 30° or is displaced by more than 3 mm.
A mechanical movement blockage always requires an open surgical procedure in which the bone lock is released and the cartilage or bone pieces are removed.
Open fractures are surgical emergencies, they must be surgically rinsed in the operating room and wound care with antibiotics, even if the wound is small.
At the same time, the bone injury is also stabilized.
Fracture type I
The fractures are usually small, they look like cracks and the bone fragments stay together.
It is possible that the fracture is initially not visible on the X-ray; this changes if the X-ray is repeated a few days after the accident.
The conservative, i.e. non-surgical treatment provides for the wearing of a splint for a few days, after which the elbow must be moved.
If movement is started too early and too quickly, the fracture can shift.
Fracture type II
The type II fractures are slightly displaced and affect a large section of bone.
With a minimal displacement, it is sufficient to put on a splint for one to two weeks and then perform a series of physiotherapy exercises.
Small bone fragments can be surgically removed.
If the fragment is large and can be attached to the end of the bone, the surgeon will try to attach it with the help of screws or pins.
If this is not possible, the surgeon removes the fragments or the spoke head.
In elderly, less active people, the doctor may simply remove the piece of bone or the entire head of the spoke.
The orthopedist must also repair soft tissue injuries, such as a torn ligament.
Fracture type III
Type III fractures consist of numerous bone fragments that cannot be combined.
Normally, there is considerable damage to the joint and ligaments here.
Surgery is always necessary to remove the small pieces of bone, including the spoke head, and to treat the injured soft tissues.
To avoid joint stiffening of the elbow, the forearm must be stretched and bent as soon as possible.
If there is a serious instability, an implant can be inserted to prevent deformation of the elbow.
Even a simple fracture will most likely result in an extensibility deficit of the elbow joint forever.
In most cases, this limitation does not cause any loss of function.
Regardless of the type of fracture and method of treatment, physiotherapy is essential to regain the old state of health.
Early complications of spoke head fractures or dislocations include: injuries to the nerves and blood vessels, infections, and compartment syndrome.
Complications that occur later include: missing or delayed consolidation, rupture of the surgically used osteosynthesis agents, axial misalignment of the bones, infection, synostosis (bone adhesion) and persistent pain.
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- spoke fracture, classification
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