The radial head of the elbow acts as a secondary stabilizer of the joint creating 30% of the elbow’s resistance to valgus forces as such it is prone to compressive forces and hyperextension injuries. Because of their proximity, the medial collateral ligament, lateral collateral ligament and interosseous ligaments are most prone to injury with radial head fractures. These fractures are typically seen in isolation, but may be accompanied by other fractures, dislocations or soft tissue injuries. Mechanism of injury is usually a fall on an outstretched arm, and in rare cases, direct trauma. It has been reported that in children the incidence of radial head and neck fractures is up to 1.3%. The vast majority of these fractures occur in individuals between the ages of 30-60 years, with a mean age between 45 and 45.9 years and are more common in women than men. They represent approximately 5.4 percent of all fractures, between 1.5 and 4.5 percent of fractures in adults, and approximately one third of all fractures of the elbow. Fractures of the radial head are relatively common. It is easy for the clinician to ignore the obvious diagnosis of fracture due to the length of time the patient has endured this condition. They occasionally present in the private practice setting, especially as a chronic presentation. Traumatic injuries to the forearm are a common occurrence in the emergency room setting. This case study demonstrates the thorough clinical examination, imaging and decision making that assisted in appropriate patient diagnosis and management. This report discusses triage of an elbow fracture presenting to a chiropractic clinic. The patient was referred for medical follow-up with an orthopedist. Plain film radiographs of the left elbow and forearm revealed a transverse fracture of the radial neck with 2mm displacement-classified as a Mason Type II fracture. The complaint originated three weeks prior following a fall on her left elbow while hiking. Clinical featuresĪ 59-year old female presented to a chiropractic practice with complaints of left lateral elbow pain distal to the lateral epicondyle of the humerus and pain provocation with pronation, supination and weight bearing. In some cases, your elbow stiffness may be limiting enough that you require a second surgery to remove scar tissue.The purpose of this case report is to describe a patient that presented with a Mason type II radial neck fracture approximately three weeks following a traumatic injury. Regardless of the type of fracture or the treatment used, you will be prescribed exercises to restore movement and strength before resuming full activities. Depending on the fracture pattern and other associated elbow injuries, you may be placed in a splint or cast for a period of time.Įven the simplest of fractures may result in some loss of movement in the elbow. Early movement to stretch and bend the elbow is necessary to avoid stiffness.Īfter surgery to repair a radial head fracture, the surgeon will recommend no weight-bearing through the arm and no lifting objects heavier than a few pounds for 6 to 12 weeks.In these cases, an artificial radial head may be placed to improve long-term function. If the damage is severe, the entire radial head may need to be removed. Surgery is always required to either fix or remove the broken pieces of bone and repair the soft-tissue damage.In most Type III radial head fractures, there is also significant damage to the elbow joint and the ligaments that surround the elbow.Type III fractures have multiple broken pieces of bone which cannot be put back together for healing. The surgeon will also correct any other soft-tissue injury, such as a torn ligament.If this is not possible, the surgeon will remove the broken pieces of the radial head. If a fragment is large and out of place enough, the orthopaedic surgeon will first attempt to hold the bones together with screws, or a plate and screws.Small fragments of broken bone may be surgically removed if they prevent normal elbow movement or have the potential to cause long-term problems with the elbow.If displacement is minimal, treatment may involve wearing a sling or splint for 1 to 2 weeks, followed by range-of-motion exercises.Type II fractures are slightly displaced and involve a larger piece of bone. If you attempt too much motion too quickly, the bones may shift and become displaced.Nonsurgical treatment involves using a splint or sling for a few days, followed by an early and gradual increase in elbow and wrist movement (depending on the level of pain).The fracture may not be visible on initial X-rays, but can usually be seen if the X-ray is taken 3 weeks after the injury. ![]() Type I fractures are generally small cracks, and the bone pieces remain fitted together.
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