In this section
Radial neck fractures - Emergency Department
Table 1: Recommended follow-up schedule for radial neck fractures.
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
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
Timing of subsequent review and mobilisation depends in part upon nature of associated injuries
Timing of return to full contact sports depends on nature of other injuries
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).
Indications for a consultant orthopaedic surgeon opinion are:
Good radiological result (united fracture in good alignment).
Good clinical result (asymptomatic with restored forearm rotation).
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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