Radial head fracture (Mason I-IV)MANAGEMENT

ARM & ELBOW · 12 SECTIONS

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447 items

☷ Legend

01Approach to the Critical Patient/attcp40

Triage and immediate priorities

›Initial priorities

›Hemodynamic instability triggers alternate diagnosis or polytrauma pathway

›High-energy mechanism

›Multiple painful regions

›Limb threat screen

›Progressive pain out of proportion

›Increasing tightness of forearm compartments

›Open injury pathway trigger

›Wound over elbow with visible fat, bone, or deep contamination

Neurovascular and limb threat

›Neurovascular status

›Perfusion

›Radial pulse

›Capillary refill

›Motor

›Posterior interosseous nerve function

›Finger extension strength

›Thumb extension strength

›Median nerve function

›Thumb opposition

›Ulnar nerve function

›Finger abduction

›Sensory

›Radial nerve distribution

›Median nerve distribution

›Ulnar nerve distribution

›Documentation checkpoints

›Pre-immobilization exam

›Post-immobilization exam

Associated injury red flags

›Dangerous associated injury triggers

›Essex-Lopresti pattern suspicion

›Wrist pain or DRUJ pain

›Loss of forearm rotation

›Positive ulnar variance on wrist radiograph

›Elbow instability suspicion

›Gross deformity

›Mechanical block to motion

›Terrible triad suspicion

›Elbow dislocation history or deformity

›Coronoid tenderness

›Lateral collateral ligament laxity

02History/hx37

Injury context

›Presentation context

›Mechanism

›FOOSH

›Axial load through forearm

›Direct blow to elbow

›High-energy mechanism

›Timing

›Time since injury

›Prior reduction attempt

›Dominance and baseline function

›Hand dominance

›Occupational demands

Symptoms and function

›Symptom pattern

›Pain location

›Lateral elbow pain

›Forearm pain

›Wrist pain

›Functional limitation

›Loss of elbow extension

›Loss of pronation and supination

›Mechanical block sensation

›Neurovascular symptoms

›Paresthesia in hand

›Weak finger extension

Risk and modifiers

›Risk modifiers

›Bleeding risk

›Anticoagulants

›Antiplatelets

›Bone health

›Osteoporosis

›Chronic steroid use

›Prior elbow injury

›Prior fracture

›Prior surgery

›Infection risk if wound present

›Contamination

›Immunosuppression

03Physical Exam/exam34

Elbow and forearm exam

›Regional exam

›Inspection

›Swelling and effusion

›Ecchymosis

›Skin breaks

›Palpation

›Radial head tenderness

›Lateral epicondyle tenderness

›Coronoid tenderness

›DRUJ tenderness

›Range of motion

›Flexion and extension

›Pronation and supination

›Painful arc

›Mechanical block

›True block to rotation

›Pain-limited motion distinction

Stability and ligament screening

›Instability assessment

›Elbow dislocation signs

›Gross instability

›Recurrent subluxation sensation

›Lateral ulnar collateral ligament concern

›Posterolateral rotatory instability features

›Medial collateral ligament concern

›Valgus pain pattern

PITFALLS

›Common misses

›Normal initial radiographs with occult radial head fracture

›Posterior fat pad sign relevance

›Effusion without visible fracture relevance

›Essex-Lopresti injury missed when wrist not examined

›DRUJ exam omission

›Wrist imaging omission

›Posterior interosseous nerve deficit missed without finger extension testing

›Pain masking weakness

04Differential Diagnosis/ddx31

Fracture and dislocation spectrum

›Traumatic elbow differential

›Radial neck fracture

›Pediatric predominance

›Angulation on lateral view

›Coronoid fracture

›Instability marker

›Olecranon fracture

›Posterior tenderness

›Extensor mechanism pain

›Distal humerus fracture

›Supracondylar pattern

›Intercondylar pattern

›Elbow dislocation

›Posterior dislocation most common

›Terrible triad association

Mimics and soft tissue injuries

›Non-fracture injuries

›Lateral collateral ligament injury

›Instability with minimal fracture

›Medial collateral ligament injury

›Valgus instability

›Radial head subluxation

›Pediatrics

›Tendon injury

›Distal biceps tear

›Triceps tear

Coding anchors

›Coding considerations

›ICD-10-CM radial head fracture

›S52.12 category

›Laterality and encounter extension selection

›SNOMED CT concept

›Fracture of head of radius

05Laboratory Tests/lt18

When labs are needed

›Lab strategy

›No routine labs for isolated closed stable fracture

›Normal vitals

›No planned procedural sedation

›Procedural sedation pathway labs only if clinically indicated

›Significant comorbidity

›High aspiration risk scenario

›Open fracture or contaminated wound pathway

›Complete blood count for infection baseline

›Basic metabolic panel for perioperative planning

›Anticoagulation or bleeding concern

›INR for warfarin

›Platelet count if thrombocytopenia concern

Interpretation and pitfalls

›Interpretation notes

›Normal labs do not exclude compartment syndrome

›Compartment syndrome is clinical

›Elevated inflammatory markers are nonspecific

›Trauma-related elevation

06Diagnostic Tests/dt56

Scoring Systems

›Classification and clinical use

›Mason classification

›Mason I

›Nondisplaced or minimally displaced radial head fracture

›No mechanical block

›Mason II

›Displaced partial articular fracture

›Mechanical block risk

›Mason III

›Comminuted radial head fracture

›Instability risk

›Mason IV

›Radial head fracture with elbow dislocation

›High instability risk

›Management implications

›Mason I typical nonoperative with early motion

›Mason II individualized based on block and displacement

›Mason III to IV typical operative consultation

Radiographs

›Plain radiograph strategy

›Elbow radiographs

›AP view

›Lateral view

›Oblique or radial head-capitellum view

›Indirect signs

›Posterior fat pad sign

›Anterior sail sign

›Elbow effusion without visible fracture

›Associated injury imaging

›Wrist radiographs for Essex-Lopresti suspicion

›DRUJ alignment

›Ulnar variance

›Forearm radiographs if diffuse forearm pain

›Radius and ulna integrity

›Post-reduction imaging requirement

›After elbow dislocation reduction

›After splinting when alignment concern

MRI

›MRI indications

›Occult fracture with persistent pain and negative radiographs

›High suspicion and functional limitation

›Ligamentous injury assessment

›LCL complex injury suspicion

›MCL injury suspicion

›Interosseous membrane injury suspicion

›Essex-Lopresti evaluation adjunct

›Limitations

›Not required for typical uncomplicated Mason I

›CT indications

›Comminution definition for Mason III

›Fragment mapping for surgical planning

›Intra-articular extension and displacement quantification

›Mechanical block correlation

›Elbow fracture-dislocation evaluation

›Coronoid fracture extent

›Capitellar involvement

›Pitfalls

›CT does not replace stability exam and clinical suspicion

07Disposition/dispo42

Discharge criteria

›Safe discharge features

›Closed injury

›No open wound

›No gross contamination

›Neurovascularly intact

›Normal finger extension

›Normal perfusion

›Stable joint

›No recurrent subluxation

›No gross instability

›Pain controlled with oral regimen

›Able to sleep and self-care

›Reliable follow-up

›Ortho or fracture clinic access

Consultation, admission, transfer triggers

›Escalation criteria

›Elbow dislocation

›Mason IV suspicion

›Post-reduction instability

›Mechanical block to motion

›Block to pronation or supination

›Block to extension

›Suspected Essex-Lopresti injury

›Wrist pain with radial head fracture

›DRUJ instability

›Neurovascular deficit

›Posterior interosseous nerve weakness

›Worsening sensory deficit

›Open fracture

›Antibiotics timing pathway

›Urgent orthopedics

›Compartment syndrome concern

›Pain out of proportion

›Pain with passive finger stretch

Follow-up timing and restrictions

›Follow-up plan

›Mason I to stable Mason II

›Orthopedics within 7 days

›Early motion plan within 3 to 7 days if stable

›Mason III to IV or instability concern

›Orthopedics same day or within 24 hours

›Activity limits

›No lifting with injured arm until cleared

›Sling for comfort only when stable

08Treatment/t89

Immediate life-saving interventions

›Immediate priorities

›Open fracture first steps

›Cover wound with sterile saline dressing

›Initiate antibiotics within 60 minutes when feasible

›Tetanus prophylaxis per immunization status

›Limb-threatening ischemia

›If pulseless or rapidly worsening perfusion, immediate reduction of dislocation if present

›Immediate specialist escalation if perfusion not restored

›Constriction relief

›Ring removal from injured side

›Splint loosening if worsening pain or paresthesia

Immobilization and Splinting

›Immobilization plan

›Options list

›Posterior long arm splint

›Sling

›Typical choices

›Stable Mason I

›Sling for comfort

›Early range of motion as tolerated

›Painful Mason I or uncertain stability

›Posterior long arm splint at 90 degrees flexion

›Neutral forearm rotation

›Elbow dislocation or unstable pattern

›Posterior long arm splint

›Position of greatest stability per exam

›Swelling precautions

›Avoid circumferential cast in acute swelling phase

›Two-finger tightness check

›Post-immobilization checks

›Repeat motor and sensory exam

›Repeat perfusion exam

Reduction

›Reduction pathway

›Indications

›Elbow dislocation

›Neurovascular compromise

›Threatened skin

›Analgesia and anesthesia

›Non-opioid analgesia

›Acetaminophen PO 1000 mg every 6 to 8 hours

›Ibuprofen PO 400 to 600 mg every 6 to 8 hours with food

›Opioid analgesia for severe pain

›Hydromorphone PO 1 to 2 mg every 4 to 6 hours as needed

›Oxycodone PO 5 mg every 6 hours as needed

›Procedural sedation when required

›Monitoring and readiness

›Cardiac monitor

›Continuous pulse oximetry

›Capnography

›Airway equipment at bedside

›Ketamine IV option

›Initiate 1 mg/kg IV

›If inadequate sedation after 2 minutes, additional 0.5 mg/kg IV

›Emergence reactions management

›If agitation, midazolam IV 0.5 to 1 mg

›Propofol IV option

›Initiate 0.5 to 1 mg/kg IV

›Additional 0.25 to 0.5 mg/kg IV every 1 to 3 minutes to effect

›Technique principles

›Traction and countertraction

›Gentle sustained force

›Avoid repeated forceful attempts

›Post-reduction requirements

›Immediate neurovascular re-check

›Post-reduction radiographs

›Immobilization in stable position

›Failed reduction pathway

›Persistent neurovascular deficit triggers immediate specialist escalation

›Irreducible dislocation triggers urgent orthopedics

Open fracture medications and timing

›Open fracture medication pathway

›Antibiotics

›Cefazolin IV 2 g every 8 hours

›If severe beta-lactam allergy, clindamycin IV 900 mg every 8 hours

›Gross contamination or farm injury

›Add gentamicin IV 5 mg/kg once daily

›Tetanus prophylaxis

›Unknown or incomplete immunization

›Tetanus toxoid vaccine

›Tetanus immune globulin

›Up to date immunization

›Booster per schedule and wound risk

DVT prophylaxis when relevant

›Thrombosis prevention

›Not routine for isolated upper extremity immobilization

›Low baseline VTE risk

›Individualized consideration

›Prior VTE history

›Active malignancy

›Prolonged immobility

›Alignment with local protocol

›Documentation of rationale

09Special Populations/sp30

Pregnancy

›Pregnancy considerations

›Imaging safety

›Elbow radiographs acceptable with shielding when feasible

›CT only when benefits outweigh risks

›Analgesia

›Acetaminophen preferred first line

›NSAIDs avoidance in later pregnancy per obstetric guidance

›Disposition

›Lower threshold for pain control and follow-up reliability

Geriatric

›Older adult considerations

›Fragility mechanism relevance

›Low-energy FOOSH

›Osteoporosis risk

›Medication risks

›NSAID renal and GI risk

›Opioid delirium and fall risk

›Function and supports

›ADL limitation with dominant arm injury

›Higher support needs for discharge

Pediatrics

›Pediatric considerations

›Differential shift

›Radial neck fracture more common

›Supracondylar fracture consideration

›Growth plate considerations

›Physeal injury evaluation

›Nursemaid elbow mimic

›Traction mechanism

›Refusal to use arm

›Analgesia dosing

›Weight-based acetaminophen and ibuprofen per local protocol

10Background/b34

Epidemiology

›Epidemiology

›Frequency context

›Common adult elbow fracture pattern

›FOOSH mechanism predominance

›Associated injury prevalence

›Ligament injury common with displaced patterns

›Elbow dislocation association in Mason IV

Pathophysiology

›Pathophysiology

›Anatomy

›Radial head role in valgus stability

›Radial head role in longitudinal forearm stability

›Injury mechanics

›Axial load through radius to capitellum

›Valgus and rotational forces with ligament injury

›Complication mechanisms

›Stiffness from prolonged immobilization

›Chronic instability when ligament injury missed

›Proximal radial migration with interosseous membrane disruption

Therapeutic Considerations

›Therapeutic rationale

›Early motion importance

›Stiffness risk reduction

›Functional recovery improvement

›Nonoperative strategy

›Stable nondisplaced fractures with no block

›Operative strategy triggers

›Mechanical block

›Instability

›Comminution with loss of radiocapitellar congruity

›Evidence framing

›Early mobilization favored for stable Mason I and selected Mason II patterns

›Operative management often required for Mason III and Mason IV due to instability risk

›Guideline style evidence labels

›Early mobilization for stable fractures as ACEP Level B style practice standard

›Urgent consultation for elbow instability as Class I consensus style recommendation

11Patient Discharge Instructions/pdi28

Copy discharge instructions

›Discharge instructions

›Immobilization care

›Sling or splint kept clean and dry

›Avoid tightening wraps if swelling increases

›Swelling control

›Elevation above heart as much as possible for 48 to 72 hours

›Ice 15 to 20 minutes at a time, several times daily

›Activity limits

›No lifting or pushing with injured arm

›Avoid sports until cleared

›Motion guidance

›If instructed as stable, gentle elbow motion within pain limits after short rest period

›Stop if mechanical block or severe pain occurs

›Pain plan

›Acetaminophen as directed

›Ibuprofen as directed if safe

›Opioid only if prescribed, no driving after use

›Return to ED now

›Increasing pain not controlled with medication

›New numbness or weakness in hand or fingers

›Inability to extend fingers or thumb

›Hand becoming pale, cool, or increasingly swollen

›Severe forearm tightness or pain with finger movement

›Wet, broken, or too-tight splint

›Fever, redness, drainage, or worsening wound pain

›Follow-up

›Orthopedics or fracture clinic within 7 days

›Earlier follow-up if dislocation, block, or instability concern

12References/r8

Guidelines and evidence sources

›Key references

›Mason radial head fracture classification original description

›Orthopedic trauma reference standards for radial head fracture management

›AAOS related guidance on upper extremity fracture care principles

›Procedural sedation safety standards for ED reductions

›Consensus recommendations on early motion for stable elbow fractures

›Literature on Essex-Lopresti injury recognition and management

›ATLS principles for high-energy trauma screening and associated injury evaluation

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed March 6, 2026

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