What is the management for a radial head fracture in a 6 year old?

Management of Radial Head Fractures in a Six-Year-Old Child

Non-surgical management with immobilization and early active range of motion is the recommended treatment for radial head fractures in a 6-year-old child, as pediatric radial head fractures typically have excellent outcomes with conservative treatment. 1

Initial Assessment and Imaging

• Standard 3-view radiographs are the first-line imaging modality to assess fracture pattern, displacement, and articular involvement 2
• Look for concomitant fractures, which occur in up to 39% of proximal radius fractures and can be easily overlooked 1
• Assess for:
  • Degree of angulation
  • Amount of displacement/translation
  • Mechanical block to motion
  • Associated injuries

Treatment Decision Algorithm

1. For minimally displaced fractures (angulation <30° and translation <50%):

   • Non-surgical management with brief immobilization
   • Early active range of motion exercises
   • This approach yields superior outcomes in terms of patient-reported outcomes, range of motion, and complications 1

2. For significantly displaced fractures (angulation >30° or translation >50%):

   • Surgical intervention is indicated
   • Options include:
     • Closed reduction with percutaneous pinning
     • Open reduction with internal fixation
     • The choice depends on fracture pattern and stability 1

Immobilization Protocol

• Short-term immobilization (typically 3-4 weeks) 2
• Children have higher tolerance for immobilization and faster healing rates, allowing for shorter immobilization periods 2
• Progressive range of motion exercises should begin after the immobilization period 2

Follow-up and Monitoring

• Radiographic follow-up to assess healing
• Monitor for potential complications:
  • Joint stiffness (most common)
  • Rotational impairment
  • Premature physeal closure
  • Osteonecrosis
  • Radio-ulnar synostosis 1

Pain Management

• NSAIDs are recommended for pain and inflammation control 2
• Oral analgesics and ice application can provide symptomatic relief 2
• Avoid prolonged opioid use; consider multimodal and opioid-sparing protocols when possible

Rehabilitation

• Directed home exercise programs including active finger motion exercises 2
• Full recovery typically expected within 6-8 weeks 2
• For athletes, provide realistic timeline for return to sports activities 2

Important Considerations

• Pediatric radial head fractures have better outcomes than adult fractures due to greater healing potential
• More invasive procedures carry higher risk of complications in children, including growth disturbances 1
• Adequate follow-up is warranted to monitor for potential long-term sequelae 1
• If symptoms persist despite normal radiographs, consider advanced imaging (CT or MRI) to evaluate for occult fractures or soft tissue injuries 2

With proper management following this algorithm, good to excellent results are achieved in most pediatric radial head fracture cases, and long-term sequelae are rare 1.