Radial Head Fracture

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Radial Head Fracture

  1. 1.  A 25yo female presents to ED with CC elbow pain after FOOSH from slipping on ice. Pt is tender just distal to the elbow, on the lateral aspect of the forearm and refuses to pronate or supinate
  2. 2.  Minimally displaced fracture of radial head with hemarthrosis  Commonly located along the lateral joint surface of radius  Usually vertically oriented  May see step off or abrupt angulation of radial head surface  Best imaging clues (look at true lateral plain film)  Displacement (“sail sign”) of anterior fat pad  Posterior fat pad is always abnormal
  3. 3.  Sling  Ensure full passive ROM  Decreased ROM can indicate intra articular fx fragment that may require surgical treatment  Physical therapy and early mobilization to prevent frozen shoulder  Ortho follow up  For severely comminuted fractures, the radial head may be excised  Prognosis  Non-displaced fracture or successful early reduction results in minimal to no loss of elbow extension  Displaced fracture or delayed management may lead to permanently restricted range of motion, traumatic arthritis, or myositis ossificans
  4. 4.  History classically of a FOOSH—the force is transmitted along the longitudinal axis of radius, compressing the radial head agains the capitellum  Most common adult elbow injury  50% of adult elbow injuries  15% of elbow injuries in children, with supracondylar fractures being far more common  Can be associated with injuries to the radial-ulnar interosseous membrane, as well as other fractures (Colles’, scaphoid, radial capitellum, and other distal radius, ulna, and carpal fractures  Occult fractures not seen on AP and lateral views may be apparent on oblique views  Disruption of the radiocapitellar line may be only sign of radial head fracture in children
  5. 5.  Marx J MD; Hockberger R MD; Walls R MD. Rosen’s emergency medicine. 7th ed.  Simon R; Sherman S; Koenigsknecht S. Emergency orthopedics: the extremities. 5th ed. McGraw Hill Publishing.  Wheeless C R III MD. Wheeless textbook of orthopedics. www.wheelessonline.com.
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