Weight-Bearing After Radial Head Fracture
For stable, minimally displaced (Mason Type I) radial head fractures, immediate weight-bearing as tolerated is safe after a brief period of immobilization (2 days), while displaced or surgically treated fractures typically require 6 weeks of protected weight-bearing before allowing full loading through the upper extremity.
Treatment Algorithm Based on Fracture Type
Mason Type I (Non-displaced or <2mm displacement)
- Immediate mobilization protocol 1:
- Joint aspiration if significant effusion present
- Broad arm sling for 2 days only
- Begin active range of motion immediately after initial immobilization
- Weight-bearing as tolerated can begin once pain-free motion is achieved (typically within first week)
- No formal weight-bearing restrictions needed for stable fractures
- Clinical follow-up at 2 weeks; discharge if improving
- Return only if no improvement at 6 weeks
Mason Type II-III (Displaced/Comminuted) - Conservatively Treated
- Immobilization for up to 2 weeks maximum 1
- Protected weight-bearing begins at 6 weeks post-injury 2, 3
- Gradual progression to full weight-bearing by 8-12 weeks
- Early range of motion exercises within pain-free range starting at 2 weeks
Surgically Treated (ORIF or Radial Head Replacement)
- No weight-bearing through affected extremity for 6 weeks 2, 3
- This applies to:
- Open reduction internal fixation of displaced fractures
- Radial head replacement for comminuted fractures (>3 fragments)
- Complex elbow injury patterns
- Early passive and active-assisted range of motion begins immediately postoperatively
- Progressive weight-bearing after 6 weeks based on radiographic healing
Key Clinical Considerations
Stability Assessment is Critical: At the first follow-up visit, assess collateral ligament stability 1. Stable elbows can progress more aggressively with stretching beyond the painful range, while unstable patterns require prolonged protection.
Associated Injuries Change Management: The presence of elbow dislocation, coronoid fractures, or ligamentous injuries (terrible triad) mandates surgical treatment and extended non-weight-bearing protocols 4, 5.
Early Motion Trumps Early Loading: The priority is achieving early range of motion rather than early weight-bearing 5. Stiffness is a greater concern than construct failure in most radial head fractures.
Evidence Supporting Early Weight-Bearing
Recent data from polytrauma patients demonstrates that immediate weight-bearing through surgically fixed upper extremity fractures does not increase hardware failure rates 6. In a matched cohort study of clavicle fractures (analogous loading scenario), patients allowed immediate weight-bearing through walkers/crutches had identical 2.5% hardware failure rates compared to non-weight-bearing controls, with 100% union rates in both groups.
Common Pitfalls to Avoid
- Over-immobilization: Prolonged immobilization beyond 2 weeks for stable Mason I fractures leads to unnecessary stiffness 1
- Ignoring associated injuries: Failure to assess for ligamentous instability or coronoid fractures can result in chronic instability 4, 5
- Premature loading of unstable fixation: Comminuted fractures with suboptimal fixation require strict 6-week non-weight-bearing 5
- Inadequate fragment assessment: Articular fragmentation alone is not an indication for surgery if the fracture is stable and maintains radiocapitellar contact 5
Rehabilitation Progression
Weeks 0-2:
- Sling immobilization for comfort only (remove for exercises)
- Active and passive range of motion within pain-free range
- No weight-bearing for displaced/surgical cases
Weeks 2-6:
- Progressive strengthening exercises
- Continued non-weight-bearing for surgical cases
- Light functional activities for stable Mason I fractures
Weeks 6-12:
- Gradual weight-bearing progression for all fracture types
- Return to full activities based on pain-free motion and radiographic healing
The degree of initial displacement, fracture stability, and presence of associated injuries are the primary determinants of weight-bearing progression, not simply the presence of a radial head fracture itself.