Minimally Displaced Radial Head/Neck Fractures (Mason Type-I, OTA Types 21A2.2 and 21B2.1): Are We "Over Treating" Our Patients?

作者：Shulman Brandon S; Lee James H; Liporace Frank A; Ego Kenneth A^*

来源：Journal of Orthopaedic Trauma, 2015, 29(2): E31-E35.

DOI：10.1007/s12506-015-0018-9

• radial head
• Mason type-I
• cost
• radiograph
• orthopaedic trauma
• elbow

Objective: The purpose of this study was to investigate the nonoperative treatment strategies for Mason-Johnson type-I radial head fractures.
Design and Setting: 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.
Patients/Participants: A search of ICD-9 code 813.05, closed fracture of the radial head/neck, in our electronic record system yielded 82 consecutive patients.
Main Outcome Measurements: Complications and treatment interventions were recorded. Demographic, radiographic, and physical examination data were collected for all patients treated non-operatively and analyzed for association with recommendation for continued follow-up and radiographic assessment.
Results: 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.
Conclusions: 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.

• 出版日期2015-2