Practice Evidence Based Case Report

Do all fractures need full immobilisation?

BMJ 2007; 335 doi: (Published 20 September 2007) Cite this as: BMJ 2007;335:612
  1. Paul Glasziou, professor of evidence based medicine
  1. Centre for Evidence-based Medicine, Department of Primary Health Care, University of Oxford, Oxford OX3 7LF
  1. paul.glasziou{at}

As I was about to start my morning general practice clinic, the receptionist told me of a patient who was coming in with an injury and handed me a faxed report from radiology, which stated: “possible fracture of the radial head.” The “possible” suggested it was undisplaced or minimally displaced, so I wondered if it needed treating at all. While waiting for the first patient to arrive and sipping my tea, I checked the orthopaedics texts in my room and did a PubMed search.

Searching for the evidence

I went to the Clinical Queries section of PubMed Central (which is bookmarked on my Firefox toolbar) and used the narrow version of the “therapy” filter (which filters for randomised trials). I entered search terms to describe the condition “fracture and radial and head,” which brought up seven studies. Two of these studies were not trials and three were not relevant (two looked at different types of internal fixation, and one looked at different methods of reduction), which left two that were relevant. I used the most …

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