![]() ![]() However, posteriorly, the pericapsular fat is usually hidden in the olecranon groove and fossa, and its presence is indicative of fluid in the joint. A minimally elevated anterior fat pad may be seen on normal elbow radiographs. It is important to assess the radiograph for a joint effusion and where one exists, to take extra care in the assessment of the radial head. Even when a fracture cannot be identified, the presence of joint effusion in adults should be treated as a non-displaced radial head fracture.Įlbow effusions are best appreciated on a lateral projection, where fluid in the joint capsule elevates the pericapsular fat, seen as anterior or posterior fat pad sign. Radial head fractures can be subtle and easily missed on radiographs. When a fracture is not seen but there is clinical suspicion, a Coyle's view can be performed. The elbow is typically radiographed in AP and lateral projections, although an external oblique view is very frequently also obtained to better visualize the radial head. The Mason-Johnston classification can be used to further classify radial head fractures, although, in practice, most radiologists merely describe the injury. Triangular fibrocartilage complex injury at the wrist ( Essex-Lopresti fracture-dislocation) While the majority of radial head fractures are isolated, a number of other injuries may also be seen 2:įracture of the coronoid process of the ulna A direct blow to the elbow can cause a radial head fracture but is uncommon. In practice, the history is often a fall onto an outstretched arm. Radial head fractures usually occur as a result of indirect trauma, with most resulting from a fall on an abducted arm with minimal or moderate flexion of the elbow joint (0 - 80°) 2. This results in valgus pronation stress with the radial head forcibly pushed against the capitulum of the humerus 1,2. See Instructions for Authors for a complete description of levels of evidence.Although fractures of the radial head are seen in all age groups, they usually occur in adults (85% between 20-60 years of age) and more frequently in women (M: F 1:2) 2. These data suggest that prescribing PT for patients who have an isolated nondisplaced or minimally displaced fracture of the radial head or neck is not cost-effective and that instructing the patient to perform self-directed exercises will be followed by a similar outcome. After 6 weeks, there were no significant differences in outcomes. Patients who performed home exercises after sustaining a nondisplaced or minimally displaced fracture of the radial head or neck demonstrated better early function at 6 weeks compared with patients who received formal PT. At 3 months, 6 months, and final follow-up, there were no significant differences between cohorts for any outcome measure. At 6 weeks, the home-exercise cohort had better function as indicated by a significantly lower mean DASH score compared with the PT cohort (p = 0.021). There were no significant differences in demographics between cohorts. Twenty-five patients were randomized to a home-exercise cohort, and 26 patients were randomized to a formal-outpatient-PT cohort. Independent-samples t tests were utilized to compare outcome measures.įifty-one patients were enrolled in the study. Demographic data were analyzed using the Mann-Whitney U test and Fisher exact test. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores pain time to clinical healing and range of motion. The follow-up intervals were 6 weeks, 3 months, 6 months, and at least 1 year. Patients were randomized to receive outpatient PT or perform self-directed home exercise. ![]() ![]() Patients who had a nondisplaced or minimally displaced fracture of the radial head or neck and presented to 1 of 2 providers were enrolled prospectively between January 2014 and August 2016. The aim of this trial was to assess the need for formal PT following a simple fracture of the radial head or neck. Nondisplaced and minimally displaced fractures of the radial head and neck are common injuries, yet the role of physical therapy (PT) in their treatment is unclear. ![]()
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