Treatment of Nondisplaced Radial Head Fracture
Nondisplaced radial head fractures should be treated conservatively with a brief period of immobilization followed by early mobilization to prevent joint stiffness and promote optimal recovery. 1, 2
Initial Management
- Apply a sugar-tong splint or sling for comfort during the acute phase (first few days)
- Transition to early mobilization within 1-2 weeks
- Avoid prolonged immobilization as it can lead to joint stiffness, which is the most common complication 3
Treatment Protocol
Initial immobilization (3-7 days)
- Use a sling or splint for comfort and pain control
- Apply ice and elevate the arm to reduce swelling
- NSAIDs are recommended for pain and inflammation control 3
Early mobilization phase (after 3-7 days)
- Begin gentle active range of motion exercises
- Focus on elbow flexion/extension and forearm pronation/supination
- Avoid forceful movements that cause significant pain
Progressive rehabilitation (2-6 weeks)
- Gradually increase range of motion exercises
- Add progressive strengthening exercises as pain allows
- Full recovery is typically expected within 6-8 weeks 3
Imaging Follow-up
- Limited radiographic follow-up is sufficient for uncomplicated nondisplaced radial head fractures
- The American College of Radiology suggests that routine radiographs are not necessary if clinical progress is satisfactory 3
- Consider repeat imaging only if symptoms persist or worsen 3
Special Considerations
Monitor for potential complications:
- Joint stiffness (most common)
- Post-traumatic arthritis
- Persistent pain
If symptoms fail to improve or worsen after 2-3 weeks:
- Consider advanced imaging (CT or MRI) to rule out occult injuries 3
- Evaluate for associated ligamentous injuries that may have been missed initially
Evidence Quality and Recommendations
The recommendation for conservative management of nondisplaced radial head fractures is well-established. Studies have shown that early mobilization leads to better functional outcomes than prolonged immobilization 4. Long-term follow-up studies demonstrate that initial nonoperative treatment of minimally displaced radial head fractures results in predominantly favorable outcomes 4.
Pitfalls to Avoid
- Prolonged immobilization (>2 weeks) can lead to joint stiffness and delayed recovery
- Failure to recognize associated injuries (ligamentous injuries, elbow instability)
- Inadequate pain control leading to poor compliance with mobilization
- Overly aggressive early rehabilitation causing increased pain and inflammation
Remember that radial head fractures may be associated with other elbow injuries, so careful assessment for associated injuries is essential during initial evaluation and follow-up 2.