Radial Neck Fracture Splinting
For radial neck fractures, use a posterior long-arm splint (back-slab) with the elbow at 90 degrees of flexion and the forearm in neutral rotation for initial immobilization.
Splinting Approach Based on Fracture Displacement
The type of immobilization for radial neck fractures depends critically on the degree of displacement using the Judet classification system:
Minimally Displaced Fractures (Judet Type I and II)
- Judet Type I and II fractures (angulation <30°) can be managed with a short course of immobilization in either a cast or splint without closed reduction 1
- A posterior long-arm splint (back-slab) is preferred over collar-and-cuff immobilization based on evidence from pediatric supracondylar fractures showing better pain relief within the first 2 weeks with posterior splint immobilization 2
- Duration: Short-term immobilization (typically 2-3 weeks) followed by early range of motion
- Prognosis: Excellent functional outcomes expected 1
Significantly Displaced Fractures (Judet Type III and IV)
- These require closed reduction under sedation or general anesthesia, followed by immobilization 1
- If closed reduction is successful and stable: posterior long-arm splint with elbow at 90° flexion
- If unstable after reduction: percutaneous fixation with K-wires or intramedullary nailing (Métaizeau technique), followed by splinting 1, 3
Key Clinical Considerations
Important caveats:
- Assess for mechanical block to motion—this mandates reduction regardless of angulation 1
- Check for associated injuries (olecranon fracture, elbow dislocation) which are common with radial neck fractures 4
- Evaluate neurovascular status given proximity to radial nerve
- Consider ultrasound in younger children if radiographs are equivocal 4
Immobilization position:
- Elbow: 90 degrees of flexion
- Forearm: Neutral rotation (midway between pronation and supination)
- This position minimizes stress on the fracture and allows for optimal healing
Duration and Follow-up
- Initial splinting: 2-3 weeks for stable, minimally displaced fractures
- Serial radiographs at 1-2 weeks to assess for loss of reduction
- Early mobilization after initial healing period to prevent stiffness
- Most patients achieve good to very good outcomes with appropriate management 4
Common pitfall: Avoid prolonged immobilization beyond 3 weeks in stable fractures, as this increases risk of elbow stiffness without improving fracture outcomes. The goal is early protected motion once initial stability is achieved.