- fissure or margin sector fracture w/ displacement less than 2 mm;
- type I fractures may be difficult to identify;
- fat pads are intracapsular but extrasynovial;
- anterior fat pad is normally visible anterioir to coronoid fossa;
- posterior fat pad sign is pathologic & should suggest need for further oblique views, including radial head capitellum view;
- there is no mechanical block to motion;
- type I frx are nondisplaced & may be missed on routine radiographs;
- posterior fat pad sign is pathologic & should suggest further oblique views, including radial head-capitellum (RHC) view.
- Non Operative Treatment:
- undisplaced frx, should be treated non-operatively;
- these have excellent prognosis;
- aspirate hemotoma & inject joint w/ local anesthetic with epinephrine.
- patient is given a sling or splinted for a few days;
- begin early ROM, usually w/in several days or as early as pain allows.
- important to mobilized the joint early to avoid post traumatic stiffness;
- active forearm rotation is started as soon as tolerated;
- good to excellent function after 2-3 months;
- may expect some loss of extension;
- w/ concomitant post elbow dislocation, early ROM is recomended;
- early motion is assoc w/ 90 % chance of good result;
- early ROM, however, should be considered cautiosly when frx involves a large segment of the articular surface (1/3)
- in the active individual, fractures involving > one third of articular surface
should be treated w/ sling or splint support for minimum of two weeks;
- Non Union:
- non-union occurs in about 5 % of Mason Type-I injuries;
- rx of symptomatic non-union is radial head resection.
- it is not helpful to remove only non union frx frag, as this tends to cause residual radial head to subluxate;
- Misc Complications:
- include loss of elbow extension, mild loss of forearm rotation, and occasional aching with use.
Long-term results and treatment modalities of conservatively treated Broberg-Morrey type 1 radial head fractures.
Minimally displaced radial head/neck fractures (Mason type-I, OTA types 21A2.2 and 21B2.1): are we "over treating" our patients?
Treatment of traumatic effusion in the elbow joint: a prospective, randomized study of 62 consecutive patients.