Minimally displaced radial head/neck fractures (Mason type-I, OTA types 21A2.2 and 21B2.1): are we "over treating" our patients?

Abstract

The purpose of this study was to investigate the nonoperative treatment strategies for Mason-Johnson type-I radial head fractures. Retrospective review of every patient with a closed radial head/neck fracture who presented to our tertiary care specialty institution in the past 2 years. A search of ICD-9 code 813.05, closed fracture of the radial head/neck, in our electronic record system yielded 82 consecutive patients. Complications and treatment interventions were recorded. Demographic, radiographic, and physical examination data were collected for all patients treated nonoperatively and analyzed for association with recommendation for continued follow-up and radiographic assessment. Fifty-four patients (68%) had 56 nondisplaced or minimally displaced (<2 mm) radial head or neck fractures without an additional injury to the affected limb. All patients were treated nonoperatively, and no patient in this cohort developed a complication or had any medical or surgical intervention other than physical therapy. No radiographic or physical examination measure was significantly associated with recommendation for the second outpatient follow-up, third outpatient follow-up, or with the number of additional radiographs ordered beyond the initial examination. An average of 4.4 (SD, 3.3) additional x-rays were taken of each affected elbow after initial outpatient presentation. Orthopaedic surgeons are likely over treating patients with Mason-Johnson type-I radial head fractures by recommending frequent radiographic follow-up without modifying treatment, leading to unnecessary patient visits, radiation exposure, and increased costs. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.