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Radial Head Frx: Type II


- Discussion:
    - marginal radial head frx w/ displacement, depression, or angulation.
    - by definition has less than 30% of articular involvement and more than 2 mm of displacement;
    - motion may be blocked by articular step off;

- Non Operative Treatment:
    - decisions regarding treatment are made on basis of exam of elbow after administration of local anesthetic block;
    - need to determine whether restriction of forearm rotation is from displaced fracture fragments vs pain;
           - patients that cannot fully rotate the forearm after injury because of discomfort need to have hematoma aspiration and injection of lidocaine without epinephrine;
           - w/ the elbow anesthetized, it is possible to distinguish motion limited by fracture fragments from motion limited by pain;
           - note that often a reduction can be facilitated by application of firm pressure over anterolateral fracture segment, as the forearm is repeatedly supinated and pronated;
    - w/ no mechanical block, or w/ at least 20-140 deg of flexion and 70 deg of pronation and supination, then frx is be treated similar to type I frx;
           - immobilize elbow & wrist for 2-3 wks & then allow & encourage ROM;
           - early mobilization, however, should be considered cautiosly when frx involves a large segment of the articular surface (1/3);
           - in active individual, frx involving > 1/3 of articular surface should be rxed w/ sling or splint support for minimum of 2 wks;

- Operative Treatment:
    - indications for surgery:
          - articular step off more than 2 mm that cannot be closed reduced;
          - failure to achieve functional ROM after administration of local anesthetic block is indication for operative treatment, esp in younger pts; 
          - failure to achieve a satisfactory ROM after administration of local anesthetic block is indication for operative rx, esp in younger pt;
    - radial head excision:
          - immediate, complete radial-head resection is to be avoid in Type-II fracture.
          - results of acute resection of frx frag are unpredictable;
          - delayed radial-head excision:
                  - because late excision of radial head is as good as early excision, non operative management is indicated initially.
                  - consider excision if any tilt or displacemnt > 1/4 of the head;
    - ORIF of Radial Head Fractures

- Managment of Associated Injuries: (complex fractures)
     - following radial head fixation, determine whether lateral stability exists, and whether LCL repair is indicated;
     - if Essex-Lopresti injury is present, the distal ulna is splinted in supination (and in some cases is crossed pined) 

The surgical treatment of isolated mason type 2 fractures of the radial head in adults: comparison between radial head resection and open reduction and internal fixation.

Open Reduction and Internal Fixation of Fractures of the Radial Head.

Primary Nonoperative Treatment of Moderately Displaced Two-Part Fractures of the Radial Head.

Is ORIF Superior to Nonoperative Treatment in Isolated Displaced Partial Articular Fractures of the Radial Head?

Transverse Coronoid Fracture: When Does It Have to Be Fixed?