The injury could be easily missed if only the lateral view is examined. Displaced fracture of radial neckįigure 6: Sixteen year old boy with a completely displaced and severely angulated (almost 90 degrees) radial head fracture (white arrow). Monteggia variant injury requiring immediate orthopaedic referral. The radial head should point to the capitellum in all views (Figure 3).įigure 4: Fourteen- year- old boy with displaced Salter Harris type I fracture of the proximal radius and avulsion of the medial epicondyle - this demonstrates the valgus nature of the force which has caused both injuries.įigure 5: Four year old girl with a displaced Salter-Harris type II fracture of the proximal radius in association with a fracture of the proximal ulna (olecranon) - this is a In this situation, a separate AP view of the proximal radius may be needed to better assess the displacement (Figure 2).įigure 2: True AP view of proximal radius. If the patient is unable to fully extend the elbow, the AP view of the elbow may not be a true AP view of the radius (Figure 1). This is to ensure that the views obtained of the proximal radius are orthogonal. The degree of forearm rotation should be the same in each view (e.g. What radiological investigations should be ordered?Īnteroposterior (AP) and lateral view of the elbow should be ordered. elbow joint dislocation, ulna shaft fracture). Inability to perform this movement (either due to mechanical obstruction or severe pain) should prompt investigation for a more complex injury pattern.ĭeformity is not typically a feature unless there are associated injuries (e.g. There is usually pain, tenderness, and swelling over the lateral aspect of the elbow and decreased forearm rotation (pronation/supination). They can also occur as a result of a dislocation and subsequent manual reduction of the elbow joint. The most common mechanism is a fall onto the outstretched arm with a valgus stress at the elbow. Radial neck fractures account for 8% of all elbow fractures in children. How common are they and how do they occur? It is important to distinguish between these as the treatment and outcome can vary significantly.ģ. It is important to distinguish between these as the treatment and outcome can vary significantly.presence of elbow joint dislocation/relocation - see.presence of other injuries of the elbow/forearm (ligamentous and/or bony) - see.anatomical location: metaphyseal, physeal (most common Salter-Harris type II).How are they classified?įractures of the proximal radius can be classified according to: History of significant deformity at the time of injury which has improved prior to presentation should prompt the clinician to think of a spontaneously-reducedĮlbow dislocation, along with its associated complications. Severe swelling is not expected with a simple radial neck injury its presence should also prompt investigation for a more complex injury pattern Restriction to gentle passive pronation-supination, or severe pain with this movement should act as a red flag to prompt escalation to check carefully for a more complex injury pattern. These injuries need early surgical intervention to prevent long term adverse outcomes. However the treating clinician needs to be vigilant for any displacement of the radial head, or any co-existing injury to the ulna (including olecranon) or medial epicondyle which suggests a Radial neck injuries are reasonably common, and when present as isolated injuries with minimal displacement or angulation, a good outcome is anticipated What are the potential complications associated with this injury?.What is the usual ED management for this fracture?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?.
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