The role of therapeutic needle aspiration in radial head fractures
Date First Published:
March 1, 2000
Last Updated:
June 30, 2000
Report by:
Simon Carley, Specialist Registrar (Manchester STEM)
Search checked by:
Rob Birkenshaw, Manchester STEM
Three-Part Question:
In [patients with traumatic elbow effusions] is [aspiration of the joint better than conservative treatment] in [reducing symptoms and time to healing]?
Clinical Scenario:
A 17 year old female presents to the Emergency Department following a fall onto the right forearm. She complains of elbow pain and has a limited range of movement of that joint. X-ray reveals a moderate elbow effusion and an undisplaced fracture of the radial head (Manson type 1). You wonder whether aspirating the joint is worthwhile.
Search Strategy:
Medline 1966-03/99 using the OVID interface.
Search Details:
[{exp elbow OR exp elbow joint OR elbow$.mp OR exp radius OR exp radius fractures OR radial head$.mp} AND {exp aspiration OR aspiration.mp OR aspirate$.mp}] LIMIT to human and english language.
Outcome:
47 papers found of which 45 were irrelevant to the study question or of insufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Fractures of the radial head - the benefit of aspiration: a prospective controlled trial. Holdsworth BJ, Clements DA, Rothwell PN. 1987 UK | 80 adult patients with radial head fractures. Aspiration, bupivicaine injection and early mobilisation vs early mobilisation alone. |
PRCT | Range of movement | no difference | Unblinded. Randomisation method not explicit. 14 patients lost to follow up. Measurements were taken at 2,6,12,26,and 52 weeks; it is unclear which period the results presented apply to. Grip strength data is not reported. |
| Grip strength | no results reported | ||||
| Aspiration success | 3/41 could not be aspirated | ||||
| Pain after aspiration | improvement reported | ||||
| The importance of elbow aspiration when treating radial head fractures. Dooley JF and Angus PD. 1991 UK | 28 adult patients with type 1 or 2 radial head fractures. Aspiration (13) vs no aspiration |
PRCT | Pain | Better immediately after aspiration and at 3, and 6 months | Unblinded. Randomisation method not explicit. Small numbers. No statistical analysis. Non standard methods for measurement of outcomes. |
| Range of movement | Better immediately after aspiration and at 3, and 6 months |
Author Commentary:
The studies relevant to this question are very poor in design and execution. A properly designed PRCT looking at pain, mobility, time to healing and harm (infection rate) is necessary to investigate this further.
Bottom Line:
While aspiration may benefit patients with traumatic elbow effusions the evidence is too poor to recommend it as a routine procedure.
References:
- Holdsworth BJ, Clements DA, Rothwell PN.. Fractures of the radial head - the benefit of aspiration: a prospective controlled trial.
- Dooley JF and Angus PD.. The importance of elbow aspiration when treating radial head fractures.