Does a nondisplaced radial neck fracture require a splint or is an arm sling sufficient?

Management of Nondisplaced Radial Neck Fractures

An arm sling is appropriate and sufficient for the management of nondisplaced radial neck fractures, without the need for a splint. 1, 2

Treatment Rationale

Nondisplaced radial neck fractures are stable injuries that require minimal immobilization. The evidence supports a conservative approach:

• Nondisplaced or minimally displaced fractures of the radial head and neck can be effectively managed with simple immobilization 1
• Research demonstrates that these fractures do not require rigid immobilization, as they are inherently stable when nondisplaced 2
• A sling provides adequate comfort and protection while allowing some functional movement, which helps prevent stiffness and muscle atrophy

Evidence-Based Management Protocol

1. Initial Assessment:

   • Confirm diagnosis with standard radiographs (3 views) to assess fracture pattern and displacement 3
   • Ensure the fracture is truly nondisplaced (no significant angulation or displacement)
   • Rule out associated injuries that might require more aggressive management

2. Immobilization Approach:

   • Use an arm sling for comfort and protection
   • Duration of immobilization: 3-4 weeks 3
   • Clinical and radiographic reassessment at 2-3 weeks to evaluate healing progression 3

3. Rehabilitation:

   • Begin self-directed home exercises after the immobilization period 2
   • Research shows that formal physical therapy is not necessary and does not improve outcomes for these fractures 2
   • Patients who performed home exercises demonstrated better early function at 6 weeks compared to those who received formal physical therapy 2

Important Considerations

• Advantages of sling over splint:

  • Better allows for early range of motion exercises
  • Reduces risk of joint stiffness and muscle atrophy
  • More comfortable for the patient
  • Easier to remove for hygiene purposes

• Potential pitfalls to avoid:

  • Inadequate follow-up: Ensure radiographic healing before discontinuing immobilization
  • Missed associated injuries: Carefully assess for concomitant elbow or wrist injuries
  • Prolonged immobilization: Can lead to stiffness and delayed recovery
  • Failure to recognize displacement: If any displacement is present, more rigid immobilization or surgical intervention may be needed 4

Special Populations

• Elderly patients: Consider evaluation for osteoporosis risk factors 3
• Athletes: Discuss realistic timeline for return to sports activities 3
• Children: May have faster healing rates, allowing for shorter immobilization periods 3, 5

Home Exercise Program

After the immobilization period (typically 3-4 weeks), patients should begin:

• Progressive range of motion exercises
• Gentle strengthening exercises
• Full recovery is typically expected within 6-8 weeks 3

The evidence clearly demonstrates that nondisplaced radial neck fractures can be effectively managed with an arm sling, and formal splinting is not necessary for optimal outcomes.