ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 13 Number 1 1 of 4 Successful non-operative management of bilateral non- contemporary proximal radial physeal injuries in a skate- boarding teenager: a case report S Khan, S Haleem Citation S Khan, S Haleem. Successful non-operative management of bilateral non-contemporary proximal radial physeal injuries in a skate-boarding teenager: a case report. The Internet Journal of Orthopedic Surgery. 2008 Volume 13 Number 1. Abstract Bilateral radial head fractures, whether contemporaneous or otherwise, have been very rarely described in paediatric patients. We present the case of a teenage boy who fell while skate-boarding onto his elbows on two occasions seven months apart. He sustained undisplaced proximal radial physeal injuries bilaterally. These fractures were managed non-operatively, with satisfactory healing clinically and radiologically, and return to full range of movement. CASE A 13 yr old right-handed boy presented to casualty after falling on to his outstretched left hand while skate-boarding in a public place. His left elbow was tender with a reduced range of movement. Radiographs showed a displaced anterior fat pad, but no fracture (Fig 1). Upon subsequent review in fracture clinic, he did not have any residual pain, but range of movement was from 10-90 degrees of flexion, with limited supination and pronation. A repeat x-ray two months later showed a healed mal-united fracture through the epiphyseal plate (Salter-Harris type IV) with no functional improvement (Fig 2). He was started on a regime of physiotherapy to improve his range of movement. Figure 1 Figure 1: Initial radiographs Left Elbow Figure 2 Figure 2: Two months later. At seven months post-fracture, he had regained flexion to 110 degrees, with near normal pronation. He had a normal carrying angle with no valgus or varus deformity at the elbow. At this visit, his parents casually mentioned that he had suffered another fall a week ago while skate-boarding after school. Radiographs showed an undisplaced Salter- Harris type IV injury of the right radial head (Fig 3). It was decided to continue with non-operative management for both these injuries. A repeat x-ray two months after the recent fall showed some absorption in the smaller radial head fragment on the right- sided, recently injured elbow (Fig 4). This correlated clinically with a mildly reduced range of movement, such that flexion lagged by 10 degrees while extension was 10 degrees deficient in supination.