Minimally displaced radial head/neck fractures (Mason type-I, OTA types 21A2.2 and 21B2.1): are we "over treating" our patients?

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 nonoperatively 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.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.