What type of splint is recommended for a radial head fracture?

Splint Selection for Radial Head Fractures

For radial head fractures, a posterior splint with the elbow at 90 degrees of flexion and the forearm in neutral rotation is the recommended immobilization method for acute management. 1

Initial Management Approach

The American Academy of Orthopaedic Surgeons recommends using splints as the optimal choice for acute injuries with anticipated swelling, particularly for radial head fractures, as they accommodate swelling better than casts and allow for skin inspection and hygiene 1. This is especially important in the early phase of injury when swelling is expected.

For radial head fractures specifically:

• A posterior splint with the elbow at 90 degrees flexion is preferred
• The forearm should be positioned in neutral rotation
• The splint should be non-circumferential to accommodate swelling
• Duration of immobilization should be limited to approximately 48 hours 2

Treatment Based on Fracture Classification

Treatment approach varies based on the Mason classification of radial head fractures:

1. Mason Type I (non-displaced fractures):

   • Brief immobilization (48 hours) with a posterior splint
   • Early active mobilization after this period
   • Avoid cast immobilization as it may lead to stiffness 2

2. Mason Type II & III (displaced or comminuted fractures):

   • Initial posterior splint for comfort and swelling control
   • Definitive treatment may require surgical intervention depending on displacement and comminution 3

Duration of Immobilization

For radial head fractures, prolonged immobilization should be avoided:

• Limit splinting to 48 hours followed by active mobilization 2
• Excessive immobilization can lead to joint stiffness, muscle atrophy, and complex regional pain syndrome 1
• Active finger motion exercises should begin immediately following diagnosis to prevent stiffness 1

Common Pitfalls and Considerations

1. Avoiding prolonged immobilization: Unlike other fractures that require weeks of immobilization, radial head fractures benefit from early mobilization to prevent stiffness 2.

2. Monitoring for complications: Watch for:

   • Median nerve injury, which can complicate forearm fractures 4
   • Limitation of elbow extension and supination 4
   • Residual pain, which affects up to 20% of patients with Mason type I fractures 2

3. Pain management: The European League Against Rheumatism recommends NSAIDs for pain control and ice application during the first 3-5 days for symptomatic relief 1.

Follow-up Care

After the initial splinting period:

• Progressive range of motion exercises should begin
• Physical therapy may be beneficial to support mobilization 2
• Monitor for limitations in forearm rotation, which can indicate complications 3

The evidence strongly suggests that early mobilization after a brief period of splinting leads to better outcomes than prolonged immobilization for radial head fractures 2.