The scenario and image depict a patient with an isolated radial neck fracture. The elbow joint is located in two views and thus this is not a Monteggia fracture or Monteggia variant. The patient in this scenario would best be treated with closed reduction. Indications for surgical management following closed reduction are angulation >30 degrees and fracture translation >3mm.
Closed reduction is attempted with the elbow flexed at 90 degrees. Following reduction, pronation and supination are assessed and should be >60 degrees. If adequate, the forearm is casted in neutral to slight pronation for 10-14 days as this is the most functional position.
Poor prognostic indicators are fractures associated with elbow dislocations, olecranon fractures or medial epicondyle avulsions.The spontaneous correction in younger children is expected to be approximately 10 degrees.
Answer 1: Full pronation could add to deformation and is not a functional forearm position.
Answer 2: Full supination could add to deformation and is not a functional forearm position.
Answer 4: Operative indication is not indicated as this amount of displacement is tolerated.
Answer 5: Operative indication is not indicated as this amount of displacement is tolerated.
Beaty JH, Kasser JR, eds. Rockwood & Wilkins Fractures in Children. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:405-427.
Waters PM. Injuries of the shoulder, elbow, and forearm. In: Abel MF, ed. Orthopaedic Knowledge Update: Pediatrics 3. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2006:302-314.