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Radial Head Fractures
Posted: Mar 1 2022 #(C102012)
A

Radial Head Fracture in 39M

HPI

A 39-year-old male fell on ice and presents with right elbow pain. The patient was seen at an outside hospital and transferred for further evaluation of a closed head injury sustained in the fall. The patient states that he has isolated right elbow pain and denies any pain in any other extremity.

PMH

No significant past medical history

PE

A focused physical exam reveals no open wounds. There is no pain with range of motion of the shoulder and wrist. There is swelling and tenderness to palpation over the right elbow with pain throughout range of motion. The elbow is stable from 130 degrees of flexion to full extension. There is no apparent block to motion. The patient is neurovascularly intact.

Poll
1 of 11
1. In addition to plain radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
17%
168/939
Yes - additional radiographic views (aXR)
3%
32/939
Yes - CT scan (CT)
71%
675/939
Yes - MRI
1%
11/939
Yes - aXR + CT
2%
20/939
Yes - aXR + MRI
0%
3/939
Yes - CT + MRI
1%
13/939
Yes - aXR + CT + MRI
0%
2/939
Outside my area of expertise - best if I do not vote
1%
15/939
2. Would you use a classification system to guide management?
No - a classification system would not help me
29%
265/896
Yes - Mason
55%
501/896
Yes - OTA/OA
7%
67/896
Outside my area of expertise - best if I don't vote
7%
63/896
3. How would you definitively manage this patient?
Nonoperative
22%
203/915
Operative
74%
682/915
Outside my area of expertise - best if I do not vote
3%
30/915
4. If you choose Operative management, considering the patient presented to the ER at 2 PM on a weekday on the day of injury, what would be your time frame to take him to surgery and where would you do it?
I would not choose Operative Management
8%
73/871
Admit to hospital - perform surgery Same day
4%
41/871
Admit to hospital - perform surgery Next day
23%
205/871
Discharge - operate at Hospital - within 5 days
26%
235/871
Discharge - operate at Hospital - within 10 days
13%
117/871
Discharge - operate at Hospital - no time limit
0%
6/871
Discharge - operate at Surgery Center - within 5 days
9%
82/871
Discharge - operate at Surgery Center - within 10 days
7%
69/871
Discharge - operate at Surgery Center - no time limit
0%
2/871
Outside my area of expertise - best if I don't vote
4%
41/871
5. If you choose Operative management, how would you test for lateral collateral ligament (LCL) injury?
I would not choose Operative management
5%
43/847
I would not assess the LCL
4%
41/847
Physical Exam Stress Test (preop)
6%
55/847
Physical Exam Stress Test (intraoperative)
47%
399/847
Preop Stress Radiographs
1%
11/847
Intraoperative Stress Fluoroscopy
17%
152/847
MRI
3%
28/847
Combination of above
10%
88/847
Outside my area of expertise - best if I don't vote
3%
30/847
6. If you choose Operative treatment, what surgery would you perform?
I would not choose Operative management
5%
42/831
External fixation (ExFix) (includes monoplane, circular fixation)
1%
10/831
Open reduction and internal fixation (ORIF)
83%
697/831
Radial head arthroplasty
4%
38/831
Fragment excision (partial)
0%
5/831
Radial head excision (complete)
0%
5/831
Outside my area of expertise - best if I don't vote
4%
34/831
7. If you choose ORIF, what approach would you use?
I would not choose ORIF
3%
30/807
Kaplan approach (between EDC and ECRB)
26%
217/807
Kocher approach (between ECU and Anconeus)
51%
417/807
Direct lateral
9%
75/807
Other
0%
2/807
Outside my area of expertise - best if I don't vote
8%
66/807
8. If you choose ORIF, what technique would you utilize?
I would not choose ORIF
3%
26/783
K-wire(s) only
2%
18/783
Screw(s) only
31%
244/783
Plates(s) and screw(s)
58%
460/783
Outside my area of expertise - best if I don't vote
4%
35/783
9. If you choose Radial Head Arthroplasty, what type of prosthesis would you use?
I would not choose Radial Head Arthroplasty
52%
399/763
Monoblock prosthesis - uncemented
12%
93/763
Monoblock prosthesis - cemented
3%
27/763
Modular prosthesis - uncemented
22%
168/763
Modular prosthesis - cemented
2%
22/763
Other combination
0%
1/763
Outside my area of expertise - best if I don't vote
6%
53/763
10. If you choose Operative management and attained the construct shown below, when would you allow full active motion of the elbow?
I would not choose Operative management
3%
26/718
Immediately
16%
121/718
< 1 week
10%
75/718
1-2 weeks
31%
229/718
3-4 weeks
22%
161/718
5-6 weeks
7%
57/718
> 6 weeks
3%
24/718
Outside my area of expertise - best if I don't vote
3%
25/718
11. If you choose Operative management and attained the construct shown, when would you allow weight-bearing post-operatively?
I would not choose Operative management
2%
21/730
Immediately
1%
12/730
1-2 weeks
3%
22/730
3-4 weeks
11%
82/730
5-6 weeks
37%
272/730
7-8 weeks
26%
194/730
9-10 weeks
2%
19/730
11-12 weeks
6%
45/730
>12 weeks
5%
42/730
Outside my area of expertise – best if I don’t vote
2%
21/730
PROCEDURE #1 DOP: 2/23/2022

Radial head open reduction and internal fixation

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