Radial Head Fracture

Question 1

What is the MOI>

Answer 1

1. FOOSH

Question 2

What are the 3 classifications (Mason classification)

Answer 2

Type I: nondisplaced/minimally displaced
*decreased ROM, can move but hurts, wont really see on an X-ray
Type II: displaced >2mm at articular surface, or neck fractures that are angulated
Type III: severely comminuted (surgery)
**II and III have decreased ROM bc bone fragments are blocking motion

Question 3

What are the presenting symptoms?

Answer 3

1. History of falling on outstretched arm/hand
2. Pain
3. Swelling laterally
4. Decreased motion from pain with type I
5. Mechanical “block” of motion with II and III
   **inability to fully extend elbow

Question 4

What will be found during the PE?

Answer 4

1. Tender laterally over radial head
   *tenderness into forearm indicates increased soft tissue injury
2. Joint effusion
3. Crepitus
4. Decreased ROM

Question 5

What are the diagnostic testing?

Answer 5

1. X-rays (hard to see)
   *sail/fat pad sign = hemarthrosis (blood is pushing that fat away from the bone
2. CT

Question 6

What is the treatment for type I

Answer 6

1. Sling/splint with early active motion as soon as pain allows

Question 7

What is the treatment for type II?

Answer 7

1. Sling/splint with early active motion as soon as pain allows unless mechanical block present
   *aspirate and inject local anesthetic to test ROM
   *if mechanical block then surgery

Question 8

What is the treatment for type III?

Answer 8

1. Surgery to remove bone fragments and stabilize fracture pieces

Question 9

What are the adverse outcomes and when should they be referred?

Answer 9

AO: stiffness, instability, wrist pain, arthritis, surgery risks if performed
Refer: all