A 42-year-old woman presents to urgent care with persistent right elbow pain and stiffness for the past 5 days. She reports falling onto an outstretched hand (FOOSH) while hiking but initially thought it was just a sprain. Over the past few days, the pain has worsened, especially with forearm rotation, and she has noticed mild swelling and difficulty fully extending her elbow.
She has mild swelling over the lateral elbow and tenderness over the radial head on examination. She has pain with passive forearm supination and pronation with limited elbow extension due to pain. The patient has no obvious deformity, bruising, or instability, and no neurovascular deficits.
Based on the x-ray of your patient, what is your diagnosis?
- Olecranon fracture
- Distal humerus fracture
- Elbow dislocation
- Nondisplaced radial head fracture
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Answer: d. Nondisplaced radial head fracture
The x-ray shows a nondisplaced radial head fracture with no evidence of dislocation or associated injuries. The anterior fat pad sign (sail sign) indicates an intra-articular fracture. Type I radial head fractures are a common elbow injury resulting from a FOOSH mechanism and are sometimes overlooked due to minimal swelling and preserved function.
For this patient, you chose a conservative treatment plan that included a posterior splint to be worn for 1 to 2 weeks, range-of-motion exercises to prevent stiffness, and NSAIDs for pain and swelling. You instructed your patient to follow up in a week to assess her healing and range of motion and suggested she seek out orthopedic care if her pain persisted >4 weeks or if she felt her range of motion was not improving.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
