Figure 1. Anteroposterior x-ray of the right elbow.
Figure 2. Lateral x-ray of the right elbow.
A 32-year-old man presents with right elbow pain after a fall 2 days ago. He slipped on ice and fell with an outstretched hand on his right side. He reports having difficulty moving the elbow since the injury. On physical examination, the patient is able to move the elbow to -20 degrees of extension and 90 degrees of flexion. He has pain to palpation over the radiocapitellar joint. Anteroposterior and lateral radiographs of the right elbow are shown in figures 1 and 2, respectively.
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Radial head fractures are the most common type of fracture of the elbow.1,2 The mechanism of injury is typically a fall on an outstretched hand where the radial head is compressed into the capitellum.1,2 Injury severity can range from a simple nondisplaced radial head fracture to a completely displaced, comminuted fracture with associated dislocation or collateral ligament injury.2
Minimally displaced fractures with less than 2 mm of displacement can be treated nonoperatively with excellent results.2 Early motion of the elbow should be initiated as soon as pain tolerates.1 The elbow can become permanently stiff with prolonged immobilization so early motion is crucial.1 A sling can be used for the first 1 to 2 weeks to allow for elbow rest but the patient should remove the sling for gentle range of motion 2 to 3 times a day.2 Patients should be instructed to avoid any lifting with the injured arm as any valgus stress placed on the elbow could cause fracture displacement.2
Follow-up radiographs are generally performed at 1, 3, and 6 weeks after injury to be certain the fracture does not displace.2 Full range of motion of the elbow without pain is expected at 6 weeks.2 Patients may resume lifting with the injured arm when full painless range of motion is achieved and radiographs show full healing.2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
1. Tejwani NC, Mehta H. Fractures of the radial head and neck: current concepts in management. J Am Acad Orthop Surg. 2007;15(7):380-387. doi:10.5435/00124635-200707000-00003
2. Rosenblatt Y, Athwal GS, Faber KJ. Current recommendations for the treatment of radial head fractures. Orthop Clin North Am. 2008;39(2):173-185. doi:10.1016/j.ocl.2007.12.008