FRACTURES OF THE HEAD AND NECK OF THE RADIUS

1. Fracture of the radial head and neck, occurring alone, although formerly considered a rare curiosity, is not uncommon, is being observed with increasing frequency, and should always be considered in injuries of the elbow-joint.

2. The chief cause of the fracture is a fall upon the outstretched hand with the elbow extended, direct lateral blows upon the side of the head occurring much less frequently.

3. In uncomplicated cases without displacement diagnosis is often very difficult, as severe pain on pressure over the radial head, increased on attempted supination, is the only constant sign and is not peculiar to this condition, but occurs also in severe sprains of the lateral ligament.

4. The differential diagnosis from partial dislocation of the radius by elongation in children, fractures of the capitellum humeri and external condyle, and sprain of the lateral ligament is especially difficult.

5. The assistance of radiograms is of great value in cases without displacement of fragments, and in complicated lesions where the condition is masked by much swelling, often furnishing the only means of diagnosis.

6. The treatment in fractures without displacement is mobilization, massage, and passive movements; in the more severe types, fixation for two weeks at right angle, followed by massage and passive movements at once; in fractures with marked or irreducible displacement, and in old cases with loss of function, excision of the radial head, followed by active treatment.

7. In long-standing cases the prognosis of excision is influenced largely by the secondary changes in the joint consequent to disuse.

8. The fracture should always be considered of a serious nature and a grave prognosis as to future perfect function should be given in all cases with displacement, especially when treated by conservative measures alone.

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