Review Question - QID 3621

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 Answers
Answer 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.