What is the management for radial head fracture?

From the Guidelines

The management of radial head fractures should prioritize early range of motion exercises and pain control, with conservative treatment for non-displaced or minimally displaced fractures and surgical intervention for displaced or comminuted fractures, as supported by the most recent evidence 1. The goal of treatment is to restore function, alleviate pain, and prevent complications such as post-traumatic arthritis, elbow stiffness, and heterotopic ossification.

Key Considerations

• For non-displaced or minimally displaced fractures (Mason type I), conservative treatment is recommended with a brief period of immobilization in a posterior splint or sling for 3-5 days, followed by early range of motion exercises.
• Pain control typically includes NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily, with acetaminophen 1000mg every 6 hours as needed, as suggested by the American Academy of Orthopaedic Surgeons 1.
• For displaced fractures (Mason type II), if the fragment is large enough and involves more than 30% of the articular surface, open reduction and internal fixation with screws or plates may be necessary, as indicated by the clinical practice guideline summary management of distal radius fractures 1.
• Severely comminuted fractures (Mason type III) often require radial head excision or replacement with a prosthesis, especially if the fracture cannot be reconstructed or if there is associated elbow instability.

Treatment Approach

• Physical therapy should begin as soon as pain allows to prevent stiffness and restore function.
• Patients should be monitored for complications such as post-traumatic arthritis, elbow stiffness, and heterotopic ossification.
• Early intervention is crucial as prolonged immobilization can lead to permanent loss of motion and function in the elbow joint, highlighting the importance of a patient-centered approach to treatment, as emphasized by the American Academy of Orthopaedic Surgeons 1.

From the Research

Management Options for Radial Head Fractures

• Radial head fractures can be managed through various approaches, including:
  • Open reduction and internal fixation (ORIF) 2, 3
  • Radial head excision 2, 3, 4
  • Radial head replacement 2, 3, 4
  • Non-operative treatment for undisplaced or minimally displaced fractures 3, 5

Surgical Approaches

• Open treatment of radial head fractures typically involves a laterally based incision centered over the radiocapitellar joint, with the extensor digitorum communis (EDC) split at the midline of the radial head and elevated off the bone anteriorly and superiorly 2
• The choice of surgical approach and fixation method depends on the fracture pattern, associated injuries, and patient characteristics 2, 3, 4

Postoperative Care and Outcomes

• Early mobilization protocols have been shown to result in better outcomes compared to delayed mobilization 6
• The timing and type of mobilization may depend on the fracture characteristics and treatment method 6
• Outcomes following radial head fixation, resection, or arthroplasty are generally favorable, but may be influenced by factors such as fragment displacement, angulation, and patient characteristics 2, 3, 5

Treatment Considerations

• Associated injuries, such as ligamentous or cartilaginous injuries, should be carefully evaluated and treated 3
• Patient characteristics, such as age and comorbidities, may influence the choice of treatment modality 5
• The need for repeat operation may depend on various factors, including the initial treatment method and patient characteristics 5