Repeat 0.25 to 0.5 mg per kg every 1 to 3 minutes to effect
Antibiotics for open fracture
Cefazolin IV
2 g IV
If weight 120 kg or more, 3 g IV
If severe penicillin allergy, clindamycin IV
900 mg IV
Monitoring and complications
Complication surveillance
Stiffness risk
Prolonged immobilization increases stiffness
Heterotopic ossification risk
Higher risk with severe trauma and surgery
Chronic instability risk
Missed ligament injury
DRUJ pain developing after discharge
Essex-Lopresti late recognition
Pregnancy
Imaging considerations
Radiographs acceptable when clinically indicated
Abdomen shielding when feasible
CT only if benefits outweigh risks
Shared decision documentation
Medication considerations
Acetaminophen preferred
NSAID avoidance in third trimester
Opioid short course if needed
Lowest effective dose
Follow up
Obstetric communication if trauma significant
Geriatric
Higher fracture risk
Low energy FOOSH common
Osteoporosis screening referral
Treatment nuances
Lower tolerance for prolonged immobilization
Stiffness and loss of independence risk
Fall risk evaluation
Medication risk
NSAID renal and GI risk
Opioid delirium and fall risk
Lower starting doses
Pediatrics
Injury pattern differences
Radial neck fractures more common than true radial head fractures
Physeal injury consideration
Exam and imaging pearls
Fat pad sign important for occult injury
Comparison views rarely needed
Management
Early ortho involvement for angulated neck fractures
Immobilization often shorter
Red flags
Monteggia lesion concern with forearm deformity
Ulna fracture with radial head dislocation
Epidemiology
Frequency and context
Common adult elbow fracture pattern
Mechanism often FOOSH with valgus and axial load
Associated injuries
Ligament injury common with displaced fractures
Terrible triad association with dislocation
Pathophysiology
Anatomy and function
Radial head as secondary stabilizer to valgus stress
Radiocapitellar joint load transmission
Injury mechanics
Axial load through radius
Valgus moment causing impaction and shear
Instability mechanisms
LCL disruption leads to posterolateral rotatory instability
Interosseous membrane disruption leads to forearm longitudinal instability
Therapeutic Considerations
Early motion principle
Goal to prevent stiffness
Short immobilization for stable injuries
Stability first principle
Instability patterns need specialist management
Radial head preservation supports elbow stability
Evidence labeling
Early mobilization in stable fractures associated with better range of motion
ACEP Level C consensus statement framing
Copy discharge instructions
Radial head fracture home care
Sling or splint use as directed
Hand and finger motion several times daily
Elevation to reduce swelling
Pain control
Acetaminophen use within maximum daily dose
Ibuprofen or naproxen if safe for you
Opioid only if prescribed and only as needed
Activity restrictions
No lifting with injured arm until cleared
Avoid pushing up from chair with injured arm
Follow up
Orthopedics or fracture clinic appointment within advised timeframe
Repeat imaging may be needed
Return to ER now if
New numbness or weakness in hand
Fingers turning blue or very cold
Severe increasing pain not controlled with medication
Worsening swelling with tightness in forearm
Fever with worsening redness or drainage
New wrist pain or inability to rotate forearm
Splint too tight with worsening pain or tingling
Guidelines and reviews
Mason classification original description and subsequent orthopedic reviews
Standard classification referenced in orthopedic trauma texts
Orthopedic trauma society guidance on radial head fracture management
Early mobilization for stable fractures
Emergency medicine fracture care references
Splinting techniques and neurovascular documentation standards
Decision support and key concepts
Terrible triad injury pattern descriptions
Radial head fracture plus coronoid fracture plus elbow dislocation
Essex-Lopresti injury descriptions
Longitudinal forearm instability with DRUJ involvement
Procedural sedation safety standards in emergency care
Continuous monitoring and resuscitation readiness
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.