What is the treatment for a nondisplaced radial neck fracture?

Treatment of Nondisplaced Radial Neck Fractures

Nondisplaced radial neck fractures should be treated with a short period of immobilization (3 weeks) in a cast or splint followed by self-directed exercises, without the need for formal physical therapy. 1

Initial Management

1. Immobilization Options:

   • Use a short-arm cast or removable splint for immobilization 2
   • For minimally displaced fractures, rigid immobilization is preferred over removable splints 2

2. Duration of Immobilization:

   • 3 weeks of immobilization is recommended rather than longer periods 3
   • Recent evidence shows that 3 weeks of immobilization leads to better functional outcomes compared to 5 weeks (PRWE scores of 5.0 vs 8.8, p=0.045) 3

3. Radiographic Follow-up:

   • Obtain follow-up radiographs at approximately 1-2 weeks after initial immobilization to ensure fracture alignment is maintained 2
   • Additional radiographic evaluation should be performed at the cessation of immobilization (3 weeks) 2

Rehabilitation Protocol

1. Exercise Program:

   • Self-directed home exercises are recommended after cast removal 1
   • Formal physical therapy is not necessary and does not improve outcomes 1
   • Patients who perform home exercises demonstrate better early function at 6 weeks compared to those receiving formal PT 1

2. Monitoring Progress:

   • Assess range of motion, pain levels, and functional ability after cast removal
   • Most patients achieve excellent functional outcomes with this conservative approach 1

Special Considerations

1. When to Consider Surgical Management:

   • Surgery is indicated if there is:
     • Postreduction radial shortening >3 mm
     • Dorsal tilt >10°
     • Intra-articular displacement or step-off 2
     • Mechanical block to motion 4

2. Complications to Monitor:

   • Secondary displacement (rare in nondisplaced fractures) 3
   • Stiffness (which is minimized by shorter immobilization periods) 3, 5
   • Pain persistence

Clinical Pearls

• Shorter immobilization (3 weeks) leads to better functional outcomes with no increase in complications compared to longer immobilization periods 3
• The risk of secondary displacement is low with proper initial immobilization 3
• Self-directed exercises are as effective as formal physical therapy, making them more cost-effective 1
• Current research is investigating even shorter immobilization periods (1 week) for younger adults, but 3 weeks remains the current standard of care 5

This treatment approach prioritizes functional outcomes while minimizing unnecessary healthcare utilization, leading to optimal morbidity, mortality, and quality of life outcomes for patients with nondisplaced radial neck fractures.