Jock Doc

Elbow injury can be treated without a cast

Q. I fell last week and injured my right elbow. I went to the emergency room, where I got X-rays and was told I might have a fracture of “my radial head.” They put me in a half cast and told me to see an orthopedic surgeon. I went to the doctor, who took a new X-ray. He said I did have a radial head fracture but all I needed was a sling and to begin moving my elbow. I thought it was weird that I could have a fracture and not need a cast.

A. The elbow joint is made up of three bones. The end of the humerus “arm” articulates with the upper part of the ulna “coranoid” and the upper part of the radius “radial head.” If a fracture of the radial head occurs — where the bone is significantly out of place or angulated — surgery is usually required. If a radial head fracture occurs that is minimally out of place and is well aligned, these usually can be treated non-surgically.

Years ago these would be immobilized until the fracture healed but this resulted in significant elbow stiffness and usually the inability to straighten the elbow out. If your orthopedic surgeon feels the fracture is stable and not likely to come out of place, then these are usually not cast but treated briefly with a sling and then early range of motion exercises. This is done very carefully so the fracture does not come out of place but usually results in more normal range of motion when the fracture has healed. It does sound like your orthopedic surgeon is giving you good advice but if you are concerned you can certainly get a second opinion from another orthopedic surgeon or upper extremity specialist.

Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net

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