Treatment of Undisplaced Fracture of the Left Radial Neck
The optimal treatment for an undisplaced fracture of the left radial neck is conservative management with splinting for 3-4 weeks, followed by progressive range of motion exercises. 1
Initial Management
- Standard radiographic examination should include multiple views to properly visualize the fracture 1
- CT without IV contrast can be used for better visualization of fracture morphology in equivocal cases 1
- For undisplaced radial neck fractures, conservative management is the treatment of choice
Immobilization Protocol
- Use a splint rather than a cast for initial immobilization, as splints accommodate swelling better and allow for skin inspection 1
- Average immobilization duration is approximately 3-4 weeks 1
- Clinical and radiographic reassessment should be performed at 2-3 weeks to evaluate fracture healing progression 1
- Recent evidence suggests that a shorter immobilization period of 3 weeks may lead to better functional outcomes compared to longer immobilization periods 2
Rehabilitation Protocol
- Active finger motion exercises should begin immediately following diagnosis to prevent stiffness 1
- After the immobilization period, progressive range of motion exercises should be initiated 1
- A directed home exercise program is recommended following immobilization 1
- Full recovery is typically expected within 6-8 weeks 1
Pain Management
- NSAIDs are recommended for pain and inflammation control 1
- Ice application during the first 3-5 days can provide symptomatic relief 1
- Consider vitamin C supplementation for prevention of disproportionate pain 1
Monitoring and Follow-up
- Clinical and radiographic reassessment at 2-3 weeks to evaluate healing progression 1
- Monitor for signs of secondary displacement, which is a rare but possible complication 2
- Patient compliance with immobilization is crucial to prevent delayed healing 1
Special Considerations
- For elderly patients, evaluate osteoporosis risk factors and consider calcium and vitamin D supplementation 1
- For diabetic patients, close monitoring of skin is essential to prevent pressure points and breakdown 1
- Smoking increases the rate of nonunion and leads to inferior clinical outcomes 1
- While nonunion of radial neck fractures is rare, it can occur, particularly in older patients 3
Potential Complications
- Excessive immobilization can lead to chronic pain, joint stiffness, muscle atrophy, and complex regional pain syndrome 1
- Inadequate immobilization can result in delayed healing, malunion, and progressive displacement 1
- Low-intensity pulsed ultrasonography (LIPUS) should NOT be used as it does not accelerate healing or lower rates of nonunion 1