Radial neck fracture presenting to a Chiropractic clinic: a case report and literature review
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CHIROPRACTIC & MANUAL THERAPIES
CASE REPORT
Open Access
Radial neck fracture presenting to a Chiropractic clinic: a case report and literature review Clinton J Daniels1*, Jordan A Gliedt2 and Dennis E Enix3
Abstract Objective: The purpose of this case report is to describe a patient that presented with a Mason type II radial neck fracture approximately three weeks following a traumatic injury. Clinical features: A 59-year old female presented to a chiropractic practice with complaints of left lateral elbow pain distal to the lateral epicondyle of the humerus and pain provocation with pronation, supination and weight bearing. The complaint originated three weeks prior following a fall on her left elbow while hiking. Intervention and outcome: Plain film radiographs of the left elbow and forearm revealed a transverse fracture of the radial neck with 2mm displacement–classified as a Mason Type II fracture. The patient was referred for medical follow-up with an orthopedist. Conclusion: This report discusses triage of an elbow fracture presenting to a chiropractic clinic. This case study demonstrates the thorough clinical examination, imaging and decision making that assisted in appropriate patient diagnosis and management. Keywords: Elbow fracture, Radial head fracture, Chiropractic
Background Traumatic injuries to the forearm are a common occurrence in the emergency room setting. They occasionally present in the private practice setting, especially as a chronic presentation. It is easy for the clinician to ignore the obvious diagnosis of fracture due to the length of time the patient has endured this condition. Fractures of the radial head are relatively common. They represent approximately 5.4 percent of all fractures, between 1.5 and 4.5 percent of fractures in adults, and approximately one third of all fractures of the elbow [1-5]. The vast majority of these fractures occur in individuals between the ages of 30-60 years, with a mean age between 45 and 45.9 years and are more common in women than men [6]. It has been reported that in children the incidence of radial head and neck fractures is up to 1.3% [6]. Mechanism of injury is usually a fall on an outstretched arm, and in rare cases, direct trauma [1-3,6-9]. These fractures are typically seen in isolation, but may be accompanied by other fractures, dislocations or soft tissue * Correspondence: [email protected] 1 Private Practice, St. Louis, MO, USA Full list of author information is available at the end of the article
injuries. Because of their proximity, the medial collateral ligament, lateral collateral ligament and interosseous ligaments are most prone to injury with radial head fractures. The radial head of the elbow acts as a secondary stabilizer of the joint creating 30% of the elbow’s resistance to valgus forces as such it is prone to compressive forces and hyperextension injuries. Symptoms typically include pain and tenderness along the lateral aspect of elbow and a limited range of motion (ROM) in the elbow, forearm or wrist. A thorough phy
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