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Sling immobilization for 2 days, followed by active mobilization.
85%
4893/5778
Long-arm cast immobilization for 1 week, followed by active mobilization.
8%
454/5778
Long-arm cast immobilization for 1 week, followed by passive mobilization.
4%
207/5778
Long-arm cast immobilization for 2 weeks
1%
53/5778
Open reduction and internal fixation
2%
136/5778
Select Answer to see Preferred Response
This patient has a Mason Type I radial head fracture (minimally displaced, no mechanical block, intra-articular displacement <2mm). Non-operative treatment is recommended. Sling immobilization for 2 days followed by active mobilization is recommended. Radial head fractures occur after axial loading/fall onto a pronated, outstretched hand as the most force is transmitted from the wrist to the radial head in this position. For Type II and III fractures, open reduction and internal fixation is indicated. For Type III fractures with more than 3 fragments, radial head replacement is advocated. Radial head excision in the acute setting is generally not recommended to prevent late proximal radial migration and ulnocarpal impingement, as an easily missed Essex-Lopresti injury is possible; any patient with a painful DRUJ or mid forearm in the face of a radial head fracture should not undergo excision. Paschos et al. compared (1) immediate active mobilization vs (2) sling immobilization for 2 days, followed by active mobilization vs (3) immobilization in a cast for 7 days followed by active mobilization. Early mobilization (Groups 1 and 2) had better ROM and less pain at 4 wks. Group 2 had better pain relief than Group 1 in the first 3 days, and the best functional scores at 12wks. They recommend early mobilization after a delay of 48 hours. Tejwani et al. reviewed current management of radial head and neck fractures. Most fractures can be managed nonoperatively with early motion if there is no instability or block to elbow motion. Complex fractures require ORIF or arthroplasty (fragment >1/3 of the radial head, ORIF not possible). Figures A through D are radiographs showing an undisplaced simple (AO/OTA 21-B2.1) radial head fracture. Incorrect Answers: Answers 2, 3, 4: Immobilization for 1 week or more leads to poorer functional outcome and pain scores. Early mobilization is important at the elbow joint. Answer 5: ORIF is only indicated if there is a displaced fragment or mechanical block to motion.
3.4
(20)
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