The guidelines crafted by the New York State Workers Compensation Board are here to aid doctors, podiatrists, and other healthcare pros in delivering the right treatment for Elbow Fractures, which encompasses Non-Displaced Radial Head Fractures.
Healthcare providers, including physicians and podiatrists, can turn to these Workers Compensation Board guidelines for insights when deciding on the most fitting care for patients dealing with Elbow fractures
It’s crucial to note that these guidelines don’t replace the importance of clinical judgement or professional expertise. Ultimately, the decision about care should be a collaborative one between the patient and their healthcare provider.
Elbow Fractures, including Non-Displaced Radial Head Fractures
Elbow fractures usually happen because of falls, especially when someone lands on an outstretched hand. If the fracture is sizable, displaced, or complex (Type III), or if there’s a significant fracture with a displaced piece (Type II), it’s crucial to consult a surgeon. Uncommon capitellar fractures often occur when falling on an outstretched hand.
While there might be attempts at non-surgical treatment, most cases are believed to benefit from surgical fixation. Surgical procedures are often necessary for these fractures.
Diagnostic Criteria of Elbow Fractures, including Non-Displaced Radial Head Fractures
After digging into the victim’s medical background, analyzing the nature of the injury, and detecting significant tenderness during the physical examination, a clinical impression is pieced together, with particular attention to any concentrated discomfort over a bone. It’s crucial to assess elbow function and inspect for any deformities.
Confirming the initial impression often involves obtaining two or three x-ray views that clearly reveal a fracture. In the realm of differential diagnoses, elbow sprain and dislocation take the spotlight. If x-rays don’t show anything but suspicion persists, the next step is typically a CT scan.
Special Studies and Diagnostic and Treatment Considerations of X-rays for Elbow Fracture
To pinpoint elbow fractures, it’s recommended to conduct specialized studies and consider diagnostic and treatment aspects of X-rays. Utilizing X-rays with a minimum of two to three views proves beneficial for accurate identification.
When it comes to the primary care of elbow fractures, including cases like Non-Displaced Radial Head Fractures, certain protocols and procedures need to be follow
Cast Immobilization/Splints and Slings
Traditionally, fractures in the elbow and elsewhere have been addressed with casting, and for non-dislocated radial head fractures, slings have been a go-to treatment.
When dealing specifically with occult and non-displaced radial head fractures, it’s recommended to use elbow slings. Occult fractures, not visible on x-rays, can be suspected if there’s evidence of effusion or if the elbow can’t fully extend.
For non-displaced radial head fractures, the prescription is a sling (or splint) worn for seven days. If the fractures are clinically apparent but not visible on an x-ray, a shorter immobilization time, even as low as three days, may be considered. After seven days, a gradual transition to mobilization is advised, followed by gentle range-of-motion activities within pain tolerance.
Moving on to casts and cast bracing for select elbow fractures, these are recommended for occult or non-displaced radial head fractures. Casting, cast bracing, or post-open reduction internal fixation fractures are considered appropriate treatments for elbow fractures with minimal displacement.
The usual duration for casts is around six weeks or until sufficient healing is evident on x-rays. After a successful recovery, the next step is progressive mobilization.
In terms of medications for elbow fractures, including non-displaced radial head fractures, first-line treatments for most patients include ibuprofen, naproxen, or other NSAIDs from an earlier generation. If NSAIDs are not suitable, acetaminophen (or paracetamol) can be a viable alternative, although research suggests it might be slightly less effective than NSAIDs.
There’s evidence supporting the idea that NSAIDs are not only less risky but also equally effective in managing pain compared to opioids like tramadol.
When it comes to treating acute, subacute, chronic, or post-operative elbow fractures, using Non-Steroidal Anti-inflammatory Drugs (NSAIDs) is recommended. These medications are particularly useful for postoperative, chronic, subacute, or acute elbow fractures, and starting with over-the-counter options is a sensible approach.
There isn’t conclusive evidence favoring one NSAID over another for these indications, so using them as needed is a reasonable choice for many patients. The decision to discontinue NSAID use can be based on reduced elbow pain, ineffectiveness, or the emergence of side effects that warrant stopping the treatment.
For individuals at high risk of gastrointestinal bleeding, it’s recommended to use NSAIDs along with cytoprotective drugs like misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors. These are especially important for patients with a high-risk profile and indications for NSAIDs, particularly if a prolonged course of treatment is planned. Factors like a history of gastrointestinal bleeding, age, diabetes, and smoking increase the risk.
When considering patients at risk for cardiovascular adverse effects, acetaminophen or aspirin are the first-line treatment options due to their perceived safety. If non-selective NSAIDs are necessary, they are preferable to COX-2-specific medications. To avoid compromising the protective effects of low-dose aspirin, it’s advised to take NSAIDs at least 30 minutes after or eight hours before the daily aspirin for individuals using it for primary or secondary cardiovascular disease prevention.
Acetaminophen is recommended for addressing elbow discomfort, particularly in patients who can’t use NSAIDs.
This treatment is suitable for all patients dealing with acute, subacute, chronic, and post-operative elbow pain. The usage should align with the manufacturer’s recommendations and can be adapted as needed. However, it’s crucial to stay within the limit of four grams per day to avoid potential liver toxicity. Discontinuation can be considered when the discomfort resolves, negative effects emerge, or intolerance is noted.
When it comes to opioids, they are suggested for specific cases of severe elbow fracture pain.
Select patients, who haven’t responded well to previous treatments like acetaminophen and NSAIDs or have contraindications to NSAIDs, may benefit from opioids. Their use is particularly relevant for individuals with more severe fractures or in the initial days post-surgery. However, caution is advised, and minimal doses should be administered, as elbow fractures typically require short-term care. The frequency and dosage can be adjusted as needed, and discontinuation may be prompted by undesirable effects, deviation from prescription guidelines, or adequate pain relief that eliminates the need for opioids.
Surgery of Elbow Fractures, including Non-Displaced Radial Head Fractures
While the common belief is that surgical treatment with fixation is needed for displaced fractures and fracture fragments, there’s a lack of reliable data specifically addressing displaced fractures. In cases involving widely displaced fractures and/or comminuted pieces, radial head excision and/or radial head implant may become necessary.
Certain individuals, such as those with extensively displaced pieces, individuals requiring a speedier recovery (e.g., professional athletes), or those with the dreaded triad, might be more suitable candidates for surgical treatment of elbow fractures. The decision to undergo surgery for elbow fractures should be a collaborative one between the orthopedist and the patient, reaching an agreement based on individual circumstances and preferences.
Surgical Fixation of Displaced Elbow Fractures
For displaced elbow fractures, it is recommended to opt for surgical fixation as the preferred course of treatment.
