What is the treatment for a non-displaced radial neck fracture in an adult?

Treatment of Non-Displaced Radial Neck Fractures in Adults

Non-displaced radial neck fractures in adults should be treated with cast immobilization for 3 weeks followed by progressive rehabilitation. This approach provides optimal functional outcomes while minimizing complications and stiffness.

Initial Management

• Confirm fracture is truly non-displaced (angulation <15°, minimal comminution, no articular step-off)
• Apply a well-padded short arm cast with the elbow at 90° flexion and neutral forearm rotation
• Pain management with appropriate analgesics as needed

Immobilization Duration

Recent evidence strongly supports a shorter immobilization period for non-displaced fractures:

• 3 weeks of cast immobilization is recommended over traditional 5-6 week protocols 1
• Shorter immobilization leads to significantly better functional outcomes at 1-year follow-up as measured by PRWE and QuickDASH scores 1
• No increase in complications or secondary displacement with shorter immobilization period

Rehabilitation Protocol

After cast removal at 3 weeks:

• Begin active range of motion exercises
• Self-directed home exercises are as effective as formal physical therapy for minimally displaced radial head/neck fractures 2
• Progressive return to activities as tolerated

Monitoring and Follow-up

• Clinical evaluation at 3 weeks (cast removal)
• Radiographic assessment to ensure maintained alignment
• Follow-up at 6 weeks to assess range of motion and function
• Final follow-up at 3 months to evaluate healing and function

Special Considerations

• For elderly patients (>55 years), the same principles apply, though recent RCTs have not identified clear recommendations for optimal treatment in this population 3
• If any displacement occurs during treatment (rare with truly non-displaced fractures), reassessment is needed to determine if surgical intervention is warranted
• Patients should be educated about expected recovery timeline and potential for some residual stiffness

Common Pitfalls to Avoid

1. Prolonged immobilization: Extending cast immobilization beyond 3 weeks can lead to unnecessary stiffness and poorer functional outcomes
2. Inadequate initial assessment: Ensure fracture is truly non-displaced before proceeding with conservative management
3. Overlooking associated injuries: Carefully assess for concomitant elbow injuries that may require different management
4. Unnecessary formal physical therapy: Evidence shows self-directed home exercises are equally effective for these fractures 2

For truly non-displaced radial neck fractures in adults, this 3-week immobilization protocol provides the optimal balance between fracture healing and functional recovery.