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Clinical Practice Guidelines

Radial neck fractures - Fracture clinics

  • Fracture Guideline Index

    See also: Radial neck fractures - Emergency Department

    1. How often should these fractures be followed up in fracture clinics?
    2. What should I review at each appointment?
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion?
    5. What are the indications for discharge?

    1. How often should these fractures be followed up in fracture clinics?

    Table 1: Recommended follow-up schedule for radial neck fractures.

    Fracture type

    First appointment

    Subsequent review appointments

    Discharge advice to parents

    Isolated, minimally displaced

    At 1 week post-injury with x-ray

    At 3 weeks post-injury, for removal of backslab, x-ray and mobilisation

    At 3 months after injury, x-ray, check range of motion (ROM), discharge if no problems

    Attend GP if the child develops pain or has deterioration in elbow/forearm ROM

    2-3 months for return to full contact sports

    Isolated, where closed reduction was necessary (with or without wire to lever)

    At 1 week post-reduction with x-ray

    At 3 weeks post-reduction, for removal of backslab, x-ray and mobilisation.

    At 3 months post-reduction, x-ray, check ROM, discharge if no problems

    As above

    Isolated, where open reduction was necessary

    At 1 week post-operative with x-ray and wound check

    At 3 weeks post-operative, for removal of backslab, x-ray and mobilisation. If the operative reduction was accompanied by K-wire fixation then the wires will need removing in accordance with post-operative instructions: percutaneous wires removed in clinic, buried wires removed in theatre

    At 3 months post-operative with x-ray (looking in particular for AVN/collapse of head). If the operative reduction was accompanied by intramedullary wire/nail fixation then the wire/nail will need removing in accordance with post-operative instructions

    At 9 months post-operative, x-ray, check ROM

    At 18 months post-operative, x-ray, discharge if no problems

    Attend GP if the child develops pain, crepitus or has deterioration in elbow/forearm ROM

    Proximal radius fracture in combination with other injury around the elbow

    At 1 week post-injury with x-ray

    Timing of subsequent review and mobilisation depends in part upon nature of associated injuries

    Attend GP if the child develops pain or has deterioration in elbow/forearm ROM

    Timing of return to full contact sports depends on nature of other injuries

     

    2. What should I review at each appointment?

    With the initial appointments, look radiographically for maintenance of reduction and healing and clinically for recovery of ROM.

    With later appointments, look radiographically for alignment of radiocapitellar joint and clinically for restoration of full ROM and no symptoms.

    If the patient required operative reduction (especially open) also look for evidence of avascular necrosis (AVN).

    3. What are the potential complications associated with this injury?

    • Failure to appreciate/manage associated injuries
    • Malposition leading to dysfunction of the radiocapitellar joint and/or proximal radioulnar joint
    • Development of a radioulnar synostosis, whilst not common, is a significant complication
    • AVN collapse of the radial head (predominantly in cases that required open reduction)

    4. When should I refer for an orthopaedic consultant opinion?

    Indications for a consultant orthopaedic surgeon opinion are:

    • fracture in unacceptable position
    • malunion with concern that remodelling will not correct the deformity
    • development of AVN
    • persistent symptoms/poor recovery of ROM after three months post-injury

    5. What are the indications for discharge?

    Good radiological result (united fracture in good alignment).

    Good clinical result (asymptomatic with restored forearm rotation).

    References (Outpatient setting)

    Evans MC, Graham HK. Radial neck fractures in children: A management algorithm. J Pediat Ortho B 1999; 8(2): 93-9.

    Green NE, Van Zeeland NL. Fractures and dislocations about the elbow. In Green N, Swiontkowski M. Skeletal Trauma in Children, 4th Ed. Saunders Elsevier, Philadelphia 2009. p.207-82.

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    Content developed by Victorian Paediatric Orthopaedic Network. 
    To provide feedback, please email rch.orthopaedics@rch.org.au