Radial Head Dislocation and Fracture Recovery Options

Closed fracture of the right radial head on the right side of the right elbow?

Hello Doctor, I was in a car accident on November 30th last year.
At that time, I had an X-ray of my elbow in the emergency room, and they said there were no fractures, so no further treatment was done.
I then sought out an osteopath who manipulated my elbow, and they said it was dislocated and helped to realign it.
However, I still cannot fully straighten my arm, and my right hand cannot completely supinate.
Today, I went to an orthopedic clinic for another X-ray, and the doctor said there is a fracture.
He showed me the difference between a normal radial head and mine, which has indeed shifted from its original disc shape.
Since it has been almost three months since the injury, the doctor gave me two options: one is surgery, but there is no guarantee of full recovery (and the doctor may not even perform the surgery), and the other is rehabilitation, which may result in my hand being somewhat limited for life but would not affect my daily activities.
However, I play the cello and truly hope to regain as much function as possible.
I would like to ask for your advice, Doctor.

Xiao Man, 20~29 year old female. Ask Date: 2021/02/23

Dr. Shi Guozheng reply Orthopedics

It has been almost three months since the fracture, and it may have already healed.
If that is the case, it is still recommended to continue rehabilitation.
Radial head fractures are often difficult to diagnose, and if there is displacement, the surgical outcome may not be very favorable.

Reply Date: 2021/02/23

More Info

Radial head dislocation and associated fractures can significantly impact arm function, particularly in activities requiring fine motor skills, such as playing the cello. Your situation, following a car accident and subsequent misdiagnosis, highlights the complexities of managing elbow injuries.
Firstly, it's essential to understand the anatomy and function of the radial head. The radial head is a critical component of the elbow joint, allowing for rotation and stability. When dislocated or fractured, it can lead to pain, limited range of motion, and functional impairment. The fact that you are experiencing difficulty fully extending your arm and supinating (turning your palm upward) suggests that there may be residual issues from the injury, including potential stiffness, scar tissue formation, or even malunion of the bone.

Regarding your options, the two paths presented by your orthopedic surgeon—surgical intervention or rehabilitation—each come with their own benefits and risks. Surgery may involve realigning the radial head and stabilizing it with hardware, which could potentially restore more normal function. However, as your doctor mentioned, there are no guarantees of complete recovery, and surgical risks include infection, nerve damage, and the possibility of needing further surgeries.

On the other hand, opting for rehabilitation without surgery may lead to a more conservative recovery. Physical therapy can help improve your range of motion and strength over time, but as you noted, it may not restore full function, and you might experience some limitations in your activities, including playing the cello.
Given your desire to regain as much function as possible for your musical pursuits, I would recommend considering a few factors before making a decision:
1. Consultation with a Specialist: If you haven't already, seek a second opinion from an orthopedic surgeon who specializes in elbow injuries. They can provide insights into the latest surgical techniques and rehabilitation protocols that might enhance your recovery prospects.

2. Physical Therapy: Regardless of whether you choose surgery or not, engaging in a structured physical therapy program is crucial. A skilled therapist can guide you through exercises tailored to improve your range of motion and strength, focusing on the specific movements required for playing the cello.

3. Long-term Goals: Consider your long-term goals for playing the cello. If achieving a high level of performance is essential to you, surgical intervention might be worth the risks involved. However, if you are more focused on general use of your arm and can adapt your playing style, rehabilitation might suffice.

4. Monitoring Progress: If you choose rehabilitation, set realistic expectations and monitor your progress closely. Regular assessments with your therapist can help you adjust your program as needed and keep you motivated.

5. Alternative Therapies: Explore complementary therapies such as acupuncture or massage, which some patients find helpful in managing pain and improving mobility.

In conclusion, the decision between surgical intervention and rehabilitation should be made based on a thorough understanding of your specific injury, your personal goals, and the advice of qualified medical professionals. Your determination to regain function is commendable, and with the right approach, there is potential for significant improvement in your condition.

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