![]() She had attempted to self-manage her symptoms with home use of a transcutaneous electrical nerve stimulation (TENS) unit, which increased her symptoms, and over the counter non-steroidal anti-inflammatory (NSAID’s) medications which had no apparent effect. The pain was described as deep and was exacerbated by weight bearing exercise and twisting motions such as opening a door. She could not recall the exact mechanism of her fall. The injury began immediately following a fall onto the left elbow while hiking. This modified Mason classification system (Figure 1) is widely considered the principal radial head fracture subgrouping system, and is often referenced at time of diagnosis and treatment.Ī 59 year-old female presented to a private chiropractic clinic complaining of a three week history of generalized left elbow pain with no symptomatic referral to the upper extremity. Further modification was proposed by Johnston who sought to include fractures of the radial head with associated elbow dislocation (Type IV). In an attempt to quantify the extent of radial head involvement, Broberg and Morrey proposed that a partial radial head fracture (Type II) must be of adequate size and movement to be considered displaced, suggesting fracture of at least 30 percent of the auricular surface and 2 mm of displacement. Mason, originally described three types: non-displaced fractures (Type I) displaced partial head fractures (Type II) and comminuted, displaced fractures involving the entire head (Type III). Radial head fracture presentations are described by the Mason classification guideline. Patients presenting with a mechanism of injury consistent with known fractures should be examined radiographically. Particular attention should be paid to the presence of pain and tenderness in the interosseous membrane. A thorough physical exam should include an inspection of ROM and longitudinal and rotational joint stability, evaluating the joint for resistance to elbow flexion and extension and forearm pronation and supination stressing varus and valgus positions of the joint. Symptoms typically include pain and tenderness along the lateral aspect of elbow and a limited range of motion (ROM) in the elbow, forearm or wrist. The radial head of the elbow acts as a secondary stabilizer of the joint creating 30% of the elbow’s resistance to valgus forces as such it is prone to compressive forces and hyperextension injuries. Because of their proximity, the medial collateral ligament, lateral collateral ligament and interosseous ligaments are most prone to injury with radial head fractures. These fractures are typically seen in isolation, but may be accompanied by other fractures, dislocations or soft tissue injuries. Mechanism of injury is usually a fall on an outstretched arm, and in rare cases, direct trauma. It has been reported that in children the incidence of radial head and neck fractures is up to 1.3%. The vast majority of these fractures occur in individuals between the ages of 30-60 years, with a mean age between 45 and 45.9 years and are more common in women than men. They represent approximately 5.4 percent of all fractures, between 1.5 and 4.5 percent of fractures in adults, and approximately one third of all fractures of the elbow. Fractures of the radial head are relatively common. It is easy for the clinician to ignore the obvious diagnosis of fracture due to the length of time the patient has endured this condition. They occasionally present in the private practice setting, especially as a chronic presentation. ![]() Traumatic injuries to the forearm are a common occurrence in the emergency room setting. This case study demonstrates the thorough clinical examination, imaging and decision making that assisted in appropriate patient diagnosis and management. This report discusses triage of an elbow fracture presenting to a chiropractic clinic. The patient was referred for medical follow-up with an orthopedist. Plain film radiographs of the left elbow and forearm revealed a transverse fracture of the radial neck with 2mm displacement-classified as a Mason Type II fracture. The complaint originated three weeks prior following a fall on her left elbow while hiking. Clinical featuresĪ 59-year old female presented to a chiropractic practice with complaints of left lateral elbow pain distal to the lateral epicondyle of the humerus and pain provocation with pronation, supination and weight bearing. The purpose of this case report is to describe a patient that presented with a Mason type II radial neck fracture approximately three weeks following a traumatic injury.
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