Disclosures: Jaimie John, MD: Nothing to disclose

Case Description: The patient is a right-hand dominant female who presented with right greater than left wrist and elbow pain after falling on outstretched hands 1 month prior. At the time of injury, she was assessed by a physician who recommended no imaging or intervention. On presentation to us, she described the pain as non-radiating, 3/10, exacerbated with weight-bearing, and improved with NSAIDs. Physical examination revealed moderate swelling at bilateral elbows, decreased pronation of bilateral forearms, and tenderness over bilateral radial heads.

Setting: Outpatient office

Patient: 54-year-old female with bilateral wrist and elbow pain after a fall.

Assessment/Results: Imaging revealed bilateral nondisplaced, healing, subacute fractures of the radial head with moderate joint effusions and preserved joint spaces. As the patient was found to have a type I Mason Classification fracture, she was treated conservatively with occupational therapy utilizing therapeutic exercise, which successfully decreased her pain. Although improved, she continued to have mildly decreased range of motion.

Discussion: This is the first reported case of delayed diagnosis of bilateral radial head fractures due to mechanical fall. During initial evaluation, this diagnosis was missed due to low suspicion as bilateral radial head fractures are rare. The radial head is susceptible to fracture when a patient falls on an outstretched hand because of a 15-degree angle between the radial neck and shaft. Diagnosis can be confirmed with x-ray imaging. Radial head fractures are classified by the Mason classification system, with Mason type 1 fractures indicating nondisplaced fractures and having an excellent prognosis. However, if patients are not mobilized within 2-3 weeks post-fracture they are prone to decreased range of motion, as was the case with our patient.

Conclusion: Physicians should have high clinical suspicion for bilateral radial head fractures, as early diagnosis and appropriate management are essential in improving elbow mobility and function.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-subacute-radial-head-fractures-after-a-fall-a-case-report/