Radial head and neck fractures are the most common elbow fractures seen in adults. It is most commonly caused by a fall onto an outstretched hand impacting the radial head into the capitellum. They can also occur from direct trauma resulting in posterior elbow dilsocation. Two types of fractures are most commonly seen. A linear shear fracture of the radial head or a radial neck impaction fracture.

A small portion of the anterior fat pad is seen in normal elbows. The posterior fat pad is not normally seen as it is contained within the olecrenon fossa and therefore should not be visible. When a fracture occurs, hemarthrosis distends the elbow capsule and displaces the anterior and posterior fat pads superiorly. The anterior fat pad forms a triangular opacity the so-called "spinnaker sail sign". The identification of the anterior and posterior fat pads indicates intraarticular fracture with 90% sensitivity. Approximitely half of the fractures are nondisplaced and may require an oblique projection called a radial head-capitellum view. Additionally, a disrupted comminuted radial head fracture is associated with disruption of the distal radial-ulnar joint (TFC tear), called a Essex-Lopresti fracture. Therefore, wrist films should be obtained when there is associated wrist pain.