David Nelson , MD
Private Practice, San Francisco
Webmaster, eRadius
Associate Editor, J Hand Surgery
Director, San Francisco Bay Area Hand Club

(case submitted May 28, 2008)

The patient is a 88 YO woman who slipped on wet wood in a carport, falling forward and sliding 15 feet on her chest and face, ending up under a car. She was brought to the ER. She lives alone in an assisted living facility and does not drive. However, she cooks her own meals and is quite independent with shopping and going out in the community. She has a R total hip but walks without any aids.

In the ER, she was diagnosed with a pulled left hamstring, a left radial head fracture that is nondisplaced and will be treated in a splint. The following xrays were taken of her right arm:

These are the xrays (PA, oblique, lateral) obtained on presentation to the ER

The patient has no median nerve symptoms and is quite interested in getting back to her normal activities.

(1) How would you describe the fracture?

(2) What additional considerations are there in this case?

(3) What are the treatment options? Which one would you suggest?

(4) Would you attempt a closed reduction? Why or why not? What would be the goals of the closed reduction?


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