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Immobilization in full pronation
1%
21/2872
Open reduction
2%
58/2872
Closed reduction
61%
1747/2872
Closed reduction and percutaneous pinning
27%
778/2872
Open reduction and internal fixation
9%
253/2872
Select Answer to see Preferred Response
The scenario and image depict a patient with an isolated radial neck fracture. The next best step is an attempted closed reduction as the report notes angulation >30. If angulation is >60 degrees, then closed reduction is not likely.Techniques of closed reduction include applying extension, varus stress, and manual pressure; elbow flexion with forearm pronation and manual pressure(Israeli method), and the Esmarch method. Open reduction commonly causes iatrogenic stiffness and should be avoided unless an acceptable closed reduction restoring motion is unsuccessful. While acceptable tolerances are controversial, anatomic reduction is not required. Once reduced, the fractures are commonly stable and do not require fixation.Illustration A and B show a pediatric radial neck fracture.Incorrect AnswersAnswer 1: The presenting alignment is not acceptable. Answer 2: Open reduction may cause iatrogenic stiffness and should be avoided if possible. Answer 4: Percutaneous pinning is not required if the reduction is stable. Answer 5: Open reduction may cause iatrogenic stiffness and should be avoided if possible.
2.2
(59)
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