Mahmoud Samer S S, Moideen Abdul Nazeer, Kotwal Rahul, Mohanty Khitish
Trauma and Orthopaedics Department, University Hospital Wales, 49 Ashridge Way, Morden, Surrey, SM4 4ED, UK,
Eur J Orthop Surg Traumatol. 2014 Oct;24(7):1133-7. doi: 10.1007/s00590-013-1386-8. Epub 2013 Dec 11.
Despite being the most common fracture around the elbow, the management of Mason type 1 radial head fractures lacks a clear protocol in literature. The aims of this study were to assess our practice of managing this injury and to create guidance for the management of these fractures based on literature review.
We designed a survey investigating the practice of orthopaedic surgeons in the management of Mason type 1 fracture. The literature review was carried out looking for the best practice guidelines.
Forty-nine surgeons (out of 56) responded, and mean duration of immobilisation was 11.69 days with the collar and cuff sling as the preferred method. 65.3% offered physiotherapy service to their patients. 20.4% recommended plain radiographic imaging follow-up. Mean duration of follow-up was 43.9 days. Decision to discharge the patient was mostly (77.6%) dependent on clinical improvement at time of last examination. 4.1% of treatment decisions were evidence based.
We observed a wide variation in the management of this common injury. Based on the current literature, the best protocol for the management of type 1 radial head fractures should be joint aspiration, followed by immobilisation in a broad arm sling for 2 days. At the first outpatient visit, assessment of the collateral stability should be performed. Patients with stable elbows should be encouraged to stretch these beyond the painful range. Patients can be discharged at this stage with an advice to come back for a clinical and radiographic assessment if there is no improvement at 6 weeks.
