2. 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
3.
4. 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
5. 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
6. 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
7.
8.
9. 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.